Failure to Maintain Proper Catheter Care and Infection Control
Penalty
Summary
The facility failed to implement proper infection control measures for a resident with an indwelling urinary catheter. The resident, who had a diagnosis of neuromuscular dysfunction of the bladder and no cognitive impairment, was observed on two separate occasions with her catheter urinary collection bag and drainage tube in direct contact with the ground. On one occasion, the resident was being assisted outside by staff, and the catheter bag was seen dragging on the pavement beneath the wheelchair, with the drainage tube tip also hitting the pavement. On another occasion, the resident was asleep in her wheelchair in the dining room, and the catheter bag and drainage tube tip were again observed touching the floor. The Director of Nursing confirmed during an interview that catheter bags should remain off the floor and in a privacy bag. However, a review of the facility's catheter care policy revealed that it did not specify that urinary catheter bags should be kept off the floor. These observations and the lack of clear policy guidance contributed to the deficient practice identified by surveyors.