Failure to Follow Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The facility failed to maintain and follow its infection prevention and control program (IPCP) as required, specifically in relation to the use of personal protective equipment (PPE) during wound care for a resident on enhanced barrier precautions (EBP) due to an abdominal wound. According to CDC guidelines and the facility's own policies, staff are required to wear both gloves and a gown during high-contact care activities, such as wound care, for residents with wounds or indwelling medical devices. Observations revealed that a registered nurse (RN) provided wound care to the resident while only wearing gloves and failed to don a gown, despite clear signage on the resident's door and established protocols indicating the necessity of both gloves and a gown for such care activities. Interviews with the resident confirmed that nurses consistently did not wear gowns during dressing changes or when managing the wound vacuum device, only using gloves. Staff interviews further corroborated this, with a certified nurse aide (CNA) stating she wore both gloves and a gown for high-contact care, while the RN admitted to forgetting to wear a gown during the observed wound care. The director of nursing (DON) and the infection preventionist (IP) both acknowledged the requirement for staff to use gloves and gowns for residents on EBP during high-contact care, and the DON described the facility's procedures for signage, PPE availability, and staff education regarding precautions. Despite these policies and procedures, the failure to consistently implement the required PPE protocols during wound care for the resident on EBP was observed and confirmed through interviews. The infection preventionist also indicated some uncertainty regarding the need for gowns during certain activities, which may have contributed to inconsistent adherence to the established infection control measures.