Failure to Maintain Infection Control During Catheter and Peri-Care
Penalty
Summary
The facility failed to ensure proper infection prevention and control practices in two separate instances involving catheter and peri-care. For one resident with a Foley catheter and diagnoses including acute kidney failure and obstructive uropathy, observations on multiple occasions revealed the urinary drainage bag was lying on the floor next to the resident's recliner chair. Staff interviews confirmed that the catheter bag was frequently found on the floor, despite care plan interventions requiring the bag to be kept off the floor and below the level of the bladder. The facility was unable to provide documentation of a catheter care policy when requested. In a separate incident, a resident with dementia and urinary incontinence was observed receiving peri-care during which a nursing assistant placed soiled washcloths on the resident's overbed table, which also held personal items and was used for meals. The nursing assistant initially denied the action but later admitted to placing the soiled washcloths on a strip of plastic on the table, acknowledging that this did not adequately protect the surface from contamination. The DON confirmed that this practice was unacceptable, especially since the table was used for eating.