Failure to Implement Infection Control Precautions for Resident with MRSA
Penalty
Summary
The facility failed to implement proper infection prevention and control measures for a resident with MRSA-positive wounds who was placed on Enhanced Standard Precautions (ESP). Despite the resident's diagnosis and orders for topical antibiotic treatment, there was no ESP signage posted outside the resident's room, and no personal protective equipment (PPE) cart was available at the entrance. Observations revealed that staff, including the treatment nurse, did not wear gowns while performing wound care, and both the treatment nurse and infection prevention nurse confirmed that appropriate PPE and signage were not in place as required by facility policy. Interviews with facility staff, including the treatment nurse, infection prevention nurse, and director of nursing, confirmed that the resident should have been placed on contact precautions due to MRSA of the wounds. Facility policies reviewed indicated that contact precautions and enhanced barrier precautions require the use of gowns and gloves during high-contact care activities for residents with multidrug-resistant organisms (MDROs). The lack of signage, PPE availability, and adherence to PPE protocols during wound care constituted a failure to follow established infection control procedures.