Failure to Implement Contact Precautions and Infection Control for Scabies
Penalty
Summary
The facility failed to follow its own policy and physician orders regarding the implementation of contact precautions and infection control measures to prevent the spread of scabies among residents in the special care unit. Three residents with cognitive impairments and rashes consistent with scabies were not placed on contact precautions as required by facility policy and physician recommendations. Observations revealed that these residents were not isolated, and staff did not use personal protective equipment (PPE) such as gloves or gowns when providing care or engaging in activities with them. There were no signs posted to indicate the need for contact precautions, and PPE was not made available near the affected residents' rooms. Medical records and interviews confirmed that the residents had been diagnosed or treated for scabies, with orders for Ivermectin and, in some cases, topical Permethrin. Despite these diagnoses and orders, the residents' care plans did not address scabies or its treatment, and staff were largely unaware of the scabies outbreak or the need for infection control measures. The dermatologist's office provided written recommendations for isolation and contact precautions, but these were not implemented by the facility. Staff interviews indicated a lack of awareness about the contagious nature of the rashes and the need for PPE, with several staff members stating they would have used precautions if they had known about the scabies diagnosis. The facility's infection control nurse and DON stated that no contact precautions were implemented because there was no definitive diagnosis of scabies via skin scraping, despite clinical diagnoses and treatment orders from dermatology. All residents in the memory care unit were treated prophylactically after a staff member reported a rash and was prescribed Permethrin, but the facility did not enforce isolation or contact precautions at any point. The lack of communication and failure to follow established protocols led to the deficiency in infection control practices.