Failure to Implement Enhanced Barrier Precautions and Hand Hygiene During Resident Care
Penalty
Summary
The facility failed to implement proper infection control practices when nursing assistants did not follow enhanced barrier precautions (EBP) or perform appropriate hand hygiene during direct care for three residents. Observations revealed that staff provided perineal care, changed briefs, and handled resident equipment without donning required gowns or performing hand hygiene at critical points, such as after glove removal or after contact with soiled materials. In several instances, staff only wore gloves, disregarding posted EBP signage that directed the use of gowns for high-contact care activities, especially for residents with indwelling devices or wounds. One resident with a suprapubic catheter and dependent on staff for activities of daily living was observed receiving care without staff donning gowns, despite clear signage and care plan instructions for EBP. Staff also failed to change gloves and perform hand hygiene after providing perineal care and before handling clean items or equipment. Another resident, who previously had a wound but no longer required EBP, still had an EBP sign posted on the door, leading to inconsistent application of precautions. Staff provided care without gowns and did not consistently perform hand hygiene after glove changes or after direct care. Interviews with nursing assistants, an LPN, an RN, and the DON revealed confusion and inconsistent understanding of when EBP should be implemented, with some staff believing it was only necessary for catheter care or contagious illnesses. Facility policies required EBP for residents with wounds, indwelling devices, or infections, and mandated hand hygiene before and after glove use and after incontinence care. However, these protocols were not consistently followed during the observed care activities.