Failure to Follow Enhanced Barrier Precautions During High-Contact Care
Penalty
Summary
The facility failed to maintain infection prevention protocols for a resident who required enhanced barrier precautions due to a chronic wound. The resident, who had multiple diagnoses including diabetes with a foot ulcer, malnutrition, cognitive impairment, and an above-knee amputation, had a physician order requiring the use of gown and gloves during high-contact care activities. Observations revealed that a CNA provided bed bath and dressing care, and assisted with transferring the resident using a hoyer lift, while only wearing gloves and a mask, but not a gown as required. The CNA stated she believed gowns were only necessary if wounds were seeping, which was not the case for this resident at the time. An LPN wore a gown and gloves for wound care but removed the gown in the room after the resident refused care. Interviews with staff confirmed that gowns were not consistently used during all high-contact care activities, contrary to facility policy, which requires gowns and gloves for such activities for residents with wounds, regardless of wound drainage. The Director of Nursing acknowledged the requirement for gowns and gloves during high-contact care and indicated a need for staff re-education. Review of facility policy confirmed the expectation for PPE use during specified care activities for residents on enhanced barrier precautions.