Failure to Maintain Proper Catheter Bag Placement for Infection Control
Penalty
Summary
A deficiency was identified when a resident with a history of neuromuscular dysfunction of the bladder and urinary retention, who was dependent on staff for toileting and had an indwelling catheter, was observed with improper catheter bag placement. On two separate occasions, the resident's catheter bag was either on the floor or hanging from the bed in such a way that it touched the floor. These observations were made while the resident was lying in bed, and the bed was in its lowest position during one of the incidents. Review of the resident's care plan indicated a specific intervention to keep the catheter drainage bag below the level of the bladder and off the floor at all times. The facility's policy on indwelling catheter use and removal also required adherence to professional standards of practice and infection prevention and control procedures. During an interview, the Infection Preventionist confirmed that catheter bags should not be on the floor, indicating a failure to follow established infection control practices and standards.