Infection Control Lapse During Incontinence Care
Penalty
Summary
During a complaint investigation, it was observed that infection control measures were not properly followed during incontinence care for a resident with multiple diagnoses, including end stage renal disease and diabetes mellitus. The resident, who had intact cognition and required maximum assistance for toileting hygiene, bed mobility, and transfers, received incontinence care from two CNAs. Both staff members donned PPE appropriately, and peri care was performed using two washcloths. However, after use, the soiled washcloths were placed on the resident's bedside table rather than being immediately disposed of in a designated bag. Following the completion of care, the CNAs did not disinfect the bedside table where the soiled washcloths had been placed. One CNA later acknowledged that placing the soiled items on the bedside table was an infection control concern and stated that a bag should have been brought to the bedside for proper disposal. The deficiency was identified based on direct observation, record review, and staff interview.