Failure to Adhere to Enhanced Barrier Precautions and Hand Hygiene Protocols
Penalty
Summary
Staff failed to follow infection prevention and control protocols for a resident on enhanced barrier precautions (EBP) due to a wound on the left knee. During an early morning observation, two CNAs provided high-contact care, including transferring and changing the resident, without wearing gowns as required by the facility's EBP policy. Additionally, both CNAs did not perform hand hygiene after removing their gloves and before exiting the room, despite the facility's hand hygiene policy mandating this practice. Interviews with the involved CNAs confirmed their awareness that the resident was on EBP and that gowns and gloves were required for such care activities. Both CNAs acknowledged they did not adhere to the hand hygiene protocol after glove removal. Facility policies reviewed indicated that gowns and gloves are necessary for high-contact care under EBP, and hand hygiene is required immediately after glove removal. The Director of Nursing and Lead CNA confirmed that staff receive training on these protocols and are required to demonstrate competency.