Failure to Implement Enhanced Barrier Precautions During Resident Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program related to Enhanced Barrier Precautions for one resident. Specifically, a resident with diagnoses of dependence on renal dialysis and obstructive and reflux uropathy had a physician order for Enhanced Barrier Precautions to be implemented every shift. During an observation, an ophthalmologist was seen providing eye examination care to the resident without wearing a protective gown, which is required as part of the personal protective equipment (PPE) under Enhanced Barrier Precautions. This lapse was confirmed with the staff member involved at the time of the observation. The deficiency was identified through observations, review of facility policies and documentation, clinical record review, and staff interviews, and was cited under 28 Pa Code 201.14(a) and 28 Pa Code 201.18(d).