Failure to Implement Enhanced Barrier and Contact Precautions During Resident Care
Penalty
Summary
The facility failed to implement enhanced barrier precautions (EBP) and contact precautions during wound and incontinence care for four residents who required these infection control measures. According to the facility's policies, staff are required to use gowns and gloves during high-contact care activities, such as wound care and incontinence care, especially for residents with wounds, indwelling devices, or infections/colonization with multidrug-resistant organisms (MDROs). Despite these requirements, direct observations revealed that the Director of Nursing (DON) did not wear a gown while performing wound treatments on three residents, all of whom had wounds and/or MDROs and had EBP or contact precautions signage posted on their doors. Additionally, a CNA assisted with wound care and urinal use for one resident without wearing gloves. Another incident involved a resident with a buttock wound and significant fecal incontinence, where both the LPN and CNA providing incontinence care did not wear gowns, despite EBP signage and physician orders indicating the need for these precautions. Interviews confirmed that staff were aware of the requirement to use gowns and gloves during these care activities but failed to do so during the observed events. The deficiencies were identified through observation, interview, and record review, and involved residents with documented needs for EBP or contact precautions due to wounds or MDROs.