Failure to Implement Enhanced Barrier Precautions for Residents with Indwelling Devices and Wounds
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) for two of three residents reviewed for infection control. According to the facility's policy and CDC guidance, EBP requires the use of gowns and gloves during high-contact care activities for residents with indwelling medical devices or chronic wounds. Observations revealed that while an EBP sign was posted on one resident's door, it was missing from another resident's door who had an indwelling catheter. Additionally, required equipment such as gowns and gloves was not consistently available outside resident rooms, particularly for newly admitted residents over the weekend. Staff interviews and record reviews indicated that EBP was not consistently practiced. A CNA was observed emptying a resident's catheter without using the required PPE and did not clean the shared toilet after disposing of urine. The CNA admitted that staff do not routinely use EBP. Physician orders and medical records confirmed that both residents required EBP due to conditions such as urinary catheters, urinary tract infection with E-Coli, and chronic wounds. The lack of signage and equipment was attributed to the resident's recent admission and oversight by the admitting nurse.