Improper Perineal and Catheter Care Technique Observed
Penalty
Summary
A deficiency was identified when a certified nursing assistant (CNA) failed to provide appropriate perineal and catheter care to a male resident with an indwelling Foley catheter. The resident, who had a history of hematuria, benign prostatic hyperplasia, urinary retention, and urinary tract infection, was observed during care where the CNA reused wipes multiple times when cleaning the urethral opening of the penis. The CNA also provided incontinence care with the resident standing, despite the resident expressing discomfort and fatigue during the process. The resident's catheter tubing was observed to be hanging due to gravity during the care. Interviews revealed inconsistencies in staff training and understanding of proper catheter care techniques. The CNA involved stated she had been trained to use a new wipe for each swipe but did not recall reusing wipes during the observed care, acknowledging that reusing wipes could lead to contamination and infection. The Director of Nursing (DON) and another CNA responsible for training provided conflicting information regarding the correct procedure, with the trainer emphasizing the importance of using one wipe per swipe and performing care with the resident lying down for better access and visibility. A review of facility policies and training materials showed that while the facility conducted regular training and competency checks, the written policy did not clearly define the clean technique or specify the use of wipes versus washcloths. The Texas nurse aide curriculum referenced by the facility also lacked specific guidance on the use of wipes. The observed deficient practice of reusing wipes and providing care with the resident standing was not aligned with the training described by the staff and could contribute to infection risk.