Failure to Follow Enhanced Barrier Precautions During Direct Care
Penalty
Summary
A deficiency was identified when a certified nursing assistant (CNA) failed to follow enhanced barrier precautions (EBP) while providing direct care to a resident with a Foley catheter. The resident, a male with diagnoses including Type 2 Diabetes, hemiplegia, and chronic kidney disease, was dependent on staff for toileting hygiene and had an indwelling Foley catheter. The resident's care plan, medication administration record, and physician orders all indicated the need for EBP, specifically the use of gown and gloves during high-contact care activities. During an observation, the CNA was seen exiting the resident's room after changing the resident's brief and emptying the Foley catheter bag, carrying a bag containing a used brief and gloves. The resident confirmed that the CNA wore gloves but did not wear a gown during the care. The resident also stated that staff typically did not wear gowns when providing care to him, despite the EBP signage on his door and the presence of gowns in his room. In interviews, the CNA acknowledged that she had recently received training on infection control and EBP, understood which residents required EBP, and knew that gowns and gloves were required for direct care of residents with Foley catheters or wounds. The Director of Nursing (DON) also confirmed that staff had been trained on EBP and that the expectation was for staff to wear gowns and gloves when providing direct care to residents on EBP. Facility policy and CMS guidance were reviewed, both of which supported the requirement for gown and glove use during high-contact care for residents with indwelling devices.