Failure to Follow Enhanced Barrier Precautions During Resident Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, specifically regarding the implementation of enhanced barrier precautions (EBP) for residents with indwelling medical devices and wounds. For one resident with a suprapubic catheter and a stage II sacral pressure ulcer, the Assistant Director of Nursing (ADON) performed wound care without donning a gown, despite signage indicating EBP and active physician orders requiring such precautions. The ADON acknowledged during interview that a gown should have been worn and that failure to do so could result in contamination. In another instance, a podiatrist provided care to a resident with a gastrostomy tube and MRSA-positive sputum without initially wearing a gown or mask, despite EBP signage and a PPE bin outside the room. The podiatrist only donned the required PPE after being prompted by a nurse. Interviews with staff confirmed that EBP should be followed for residents with indwelling devices or wounds, and that appropriate PPE (gown and gloves, and mask if on droplet precautions) is required during high-contact care activities. Record reviews showed that both residents had active orders and care plans specifying the need for EBP due to their medical conditions. Facility policy also outlined the requirement for gown and glove use during high-contact care for residents with wounds or indwelling devices. However, observations and staff interviews revealed lapses in adherence to these protocols, including uncertainty about staff education and in-service documentation related to EBP.