Failure to Implement Enhanced Barrier Precautions During Resident Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program by not ensuring that enhanced barrier precautions (EBP) were implemented during care for a resident with a colostomy. The resident, an 85-year-old female with multiple diagnoses including dementia, hemiplegia, diabetes, and colostomy status, required EBP as indicated in her care plan. Observations revealed that while EBP signage and personal protective equipment (PPE) were present, staff did not consistently follow the required protocols. Specifically, two CNAs provided peri care and emptied the resident's colostomy bag while wearing gloves but failed to don gowns as required by EBP guidelines. Interviews with these CNAs indicated a lack of understanding and inconsistent application of EBP, with one CNA admitting to not always wearing a gown and being unable to explain the precautions, and the other stating she did not notice the EBP sign and sometimes omitted the gown. In contrast, a CMA was observed following proper EBP protocol by wearing both gown and gloves during resident care. Further interviews with facility leadership, including the DON, ADON, and Administrator, confirmed expectations that staff should wear gowns and gloves for residents on EBP, particularly during high-contact care activities. However, the ADON was unable to provide recent signed in-service documentation for EBP training, and there was acknowledgment that staff education on EBP had been reviewed but not consistently documented. The facility's policy outlined the requirements for EBP, including targeted gown and glove use during high-contact care, but these were not consistently followed in practice.