Failure to Follow Enhanced Barrier Precautions During Wound Care
Penalty
Summary
Staff failed to implement the facility's infection prevention and control policy for one resident who was on enhanced barrier precautions (EBP) due to a wound requiring daily care. During wound care administration, a registered nurse and a certified nursing assistant did not don the required personal protective equipment (PPE), including an isolation gown, gloves, and mask, as mandated by the facility's EBP policy. This was directly observed by another registered nurse, who confirmed that the staff did not follow the established protocol for PPE use during high-contact care activities such as wound care. The resident involved had a history of hypertension, pain, and epilepsy, and required varying levels of assistance with daily activities, including being dependent for toileting hygiene, showering, and dressing. The resident had a treatment order for a right lateral heel wound, which required cleaning, application of ointment, and dressing changes. Both the Director of Nursing and the observing registered nurse acknowledged that EBP should have been implemented during direct care to protect the resident from infection, as outlined in the facility's revised policy.