Failure to Provide Proper Perineal Care Resulting in Increased Risk of UTIs
Penalty
Summary
A deficiency was identified when staff failed to provide appropriate perineal care to a resident with a history of multiple urinary tract infections (UTIs) and MRSA in the urine. During an observation, a CNA was seen assisting a resident with perineal care after toileting. The CNA wiped the resident's rectal area and then, without changing gloves or performing hand hygiene, proceeded to clean the perineal area using a circular motion, alternating directions, and did not consistently wipe from front to back. This practice was contrary to the facility's policy and standard infection control procedures, which require cleaning the perineal area before the rectal area and changing gloves between tasks to prevent contamination. The resident involved had a history of frequent UTIs, was frequently incontinent of urine, and was dependent on staff for toileting hygiene due to severely impaired cognition. The resident had been admitted with a UTI diagnosis and had multiple documented episodes of UTIs, including MRSA in the urine, requiring contact isolation precautions. Medical records and interviews confirmed the resident's ongoing issues with UTIs and the need for strict adherence to infection prevention protocols during perineal care. Interviews with facility staff, including the CNA involved, the RN Nurse Consultant, the Administrator, and the DON, confirmed that the observed perineal care did not follow facility policy or accepted standards. Staff acknowledged the importance of proper technique, including cleaning from front to back and changing gloves between clean and dirty tasks, to prevent the introduction of bacteria to the perineal area. The facility's policy referenced the Lippincott Nursing Manual for guidance, but the provided documentation did not include specific instructions for incontinent care.