Failure to Provide Proper Perineal Care for Incontinent Male Resident
Penalty
Summary
A deficiency occurred when a male resident who was always incontinent of urine and bowel did not receive appropriate perineal care during an incontinence episode. The resident, who was dependent on staff for toileting hygiene and had diagnoses including diabetes, hemiplegia, and viral hepatitis, was observed after waiting several hours for incontinence care. Upon care, two CNAs entered the room and began cleaning the resident, who had a large amount of bowel movement present. During the process, CNA B failed to clean the resident's penile shaft and did not pull back the foreskin to clean the meatus area, as required for uncircumcised males. Additionally, CNA B changed gloves without performing hand hygiene. The resident expressed concern that not all of the bowel movement was removed from his groin area, prompting further cleaning, but the required steps for proper perineal care were still not completed. Interviews with the involved CNAs confirmed that proper perineal care steps were missed, specifically the cleaning of the penis and foreskin. The facility's policy required staff to wash the penis from the ureteral opening, pull back the foreskin on uncircumcised males, and clean under it, which was not followed in this instance. The DON also confirmed that these steps were mandatory and that failure to perform them could lead to infection. The deficiency was identified through observation, interview, and record review, and was limited to one resident reviewed for catheter and incontinence care.