Failure to Implement Enhanced Barrier Precautions and Hand Hygiene During Resident Care
Penalty
Summary
The facility failed to follow its infection control policy and procedures regarding Enhanced Barrier Precautions (EBP) and hand hygiene during care for residents with chronic wounds and indwelling medical devices. Specifically, a treatment nurse did not wear a protective gown while providing wound care for a resident with a diabetic foot ulcer, despite the facility's EBP policy indicating that diabetic foot ulcers are considered chronic wounds and require EBP during high-contact care activities. The nurse and the Director of Nursing (DON) both stated that EBP was not implemented because the wound was not present for three months, although the policy listed diabetic foot ulcers as chronic wounds regardless of duration. The Administrator later confirmed that EBP should have been implemented for this resident during wound care. Additionally, the same treatment nurse did not don a gown while providing tracheostomy and feeding tube care for another resident who was on EBP, as indicated by signage and supplies at the resident's door. The nurse performed multiple steps of tracheostomy and feeding tube care, including handling soiled dressings and cleaning around the devices, without wearing a gown as required by the facility's EBP policy. The nurse acknowledged this omission as an oversight during an interview, and both the DON and Administrator confirmed that staff are expected to follow EBP protocols during such care. The facility also failed to follow its hand hygiene policy during a dressing change for a resident with a feeding tube. The treatment nurse did not remove gloves and perform hand hygiene after removing a soiled gauze and before cleaning around the feeding tube, contrary to the facility's policy and CDC guidelines. The nurse stated she would only remove gloves and perform hand hygiene if the gloves were visibly soiled, while the DON and Administrator both indicated that hand hygiene should be performed when moving from a dirty to a clean task.