Failure to Implement Infection Control Measures for Suspected Communicable Skin Condition
Penalty
Summary
The facility failed to implement appropriate infection control measures for residents exhibiting signs and symptoms of a potentially communicable skin condition. Specifically, two residents were treated with Permethrin cream, a medication commonly used for scabies, following the development of rashes and skin lesions. Despite the presence of symptoms consistent with a contagious skin infestation and the use of a topical antiparasitic, there was no documentation that contact isolation precautions were initiated for either resident. The facility's infection control policy requires contact precautions in such cases, including the use of personal protective equipment and isolation measures, but these were not followed. Additionally, the facility did not obtain a clear diagnosis or track the infection, nor did it clarify physician orders through the infection preventionist. Medical records lacked evidence of infection tracking, follow-up assessments, or infection preventionist review. Staff interviews confirmed that the residents' room was not placed on contact isolation during treatment, and the Director of Nursing was unable to locate any documentation of infection control interventions or follow-up. At the time of the survey, the facility did not have an infection preventionist in place.