Failure to Use PPE During G-Tube Medication Administration for Residents on Enhanced Barrier Precautions
Penalty
Summary
Licensed Vocational Nurses (LVNs) failed to implement required infection control practices for two residents who were on Enhanced Barrier Precautions (EBP) due to the presence of indwelling catheters, feeding tubes, and wounds. Both residents had care plans and physician orders specifying that staff must use gowns and gloves during high-contact care activities, including medication administration via G-tube. During observations, LVNs were seen entering the residents' rooms and administering medications through G-tubes without wearing the required isolation gowns, despite the established protocols and documented requirements in the residents' records. Interviews with the involved LVNs confirmed that they were aware of the need to wear isolation gowns but failed to do so, with one stating she forgot and the other acknowledging the requirement to protect residents and prevent infection spread. The Infection Preventionist also confirmed that staff are expected to follow the designated precaution protocols and use appropriate PPE as indicated. Facility policy reviewed further supported the necessity of gowns and gloves for high-contact activities involving device care, such as feeding tubes.