Failure to Follow Enhanced Barrier Precautions and Equipment Sanitization
Penalty
Summary
Facility staff failed to follow infection control procedures for a resident who had a physician's order for enhanced barrier precautions due to wounds. On observation, a registered nurse was seen taking the resident's vital signs without wearing any personal protective equipment (PPE), such as a gown or gloves, as required by the enhanced barrier precautions. The nurse also did not sanitize the blood pressure cuff or pulse oximeter before or after use, and the equipment was subsequently handed to another staff member for use on a different resident without disinfection. Interviews with facility staff confirmed that enhanced barrier precautions require the use of gown and gloves when providing care to residents with certain infection risks, such as wounds, and that vital sign equipment should be sanitized before and after each use. Review of facility policy and CDC recommendations further supported these procedures. The failure to adhere to these protocols was acknowledged by staff and administration during the survey.