Failure to Provide Proper Perineal Care During Incontinent Care
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) failed to provide appropriate perineal care to a female resident who was incontinent of bowel and bladder. During an observation, the CNA did not separate the resident's labia while performing incontinent care, which was contrary to the facility's policy and standard infection control practices. The surveyor intervened before the CNA closed the clean brief, prompting the CNA to properly separate the labia and continue cleaning, at which point fecal matter was still present and required additional wiping to achieve cleanliness. The resident involved had a history of malignant neoplasm of the colon, hypertension, atrial fibrillation, and a cognitive communication deficit, but was assessed as cognitively intact and required assistance with activities of daily living. Interviews with the CNA, unit manager, and director of nursing confirmed that the expected procedure was not followed, as the CNA should have separated the labia and cleaned from front to back using a clean wipe for each stroke. The facility's policy on perineal care also specified these steps to reduce infection risk and promote skin integrity.