Failure to Implement Enhanced Barrier Precautions During High-Risk Resident Care
Penalty
Summary
The facility failed to implement its infection control policy and procedures for Enhanced Barrier Precautions (EBP) during direct care activities for residents with high-risk conditions. In one instance, a nurse provided care to a resident with a peripherally inserted central catheter (PICC) line by donning gloves but not a gown, and did not change gloves after touching items on the bedside table before proceeding with intravenous care. The nurse was unaware that a gown was required for PICC line care and did not realize gloves should be changed after touching potentially contaminated surfaces. The resident in question was receiving intravenous antibiotics for endocarditis and had a PICC line, which is considered an invasive device requiring EBP according to facility policy. Additionally, two nursing assistants provided turning and repositioning care to another resident who was on EBP due to a gastrostomy tube and a wound positive for MRSA, without wearing gloves or gowns. The nursing assistants did not perform hand hygiene before entering the room and believed that repositioning a resident using a draw sheet did not require personal protective equipment (PPE). Both staff members stated they had received training on EBP but found the requirements confusing, particularly regarding which activities necessitated PPE. Observations confirmed that signage indicating EBP requirements was present outside the resident's room, specifying the need for gown and gloves during high-contact care activities, including handling bed linens and device care. Interviews with facility leadership, including the Assistant Director of Nursing, Unit Manager, Wound Care Nurse, Infection Preventionist, and Director of Nursing, revealed inconsistent understanding and implementation of EBP. While leadership confirmed that residents with invasive devices or wounds should be on EBP and that PPE is required for high-contact care activities, there was a lack of clarity regarding the assignment of precautions and verification of staff competency. The Infection Preventionist and Wound Care Nurse both indicated that the resident with the PICC line should have been on EBP, but there was no signage or consistent application of precautions for this resident.