Failure to Provide Proper Perineal Care and Hand Hygiene for Incontinent Resident
Penalty
Summary
A deficiency was identified when a certified nursing assistant (CNA) failed to provide appropriate perineal care to a male resident who was frequently incontinent of bowel and bladder. During an observed care episode, the CNA did not cleanse the external urethral orifice of the penis as required by facility policy, which specifies that perineal care for male residents should begin with cleansing the urethra and then moving outward. The CNA used disposable wipes to clean the groin and penis but did not specifically clean the urethral opening. The resident was dependent on staff for all activities of daily living, including perineal hygiene, and had a care plan in place to address incontinence and prevent urinary tract infections (UTIs). The resident involved had multiple medical diagnoses, including chronic obstructive pulmonary disease (COPD), muscle weakness, mobility abnormalities, a history of stroke, anxiety, and depression. The resident was cognitively intact and required total assistance for personal hygiene. The care plan documented the need for regular checks and thorough cleaning to prevent skin breakdown and UTIs, with specific instructions to wash, rinse, and dry the perineum after episodes of incontinence. Despite these documented interventions, the observed care did not meet the established standards. Additionally, the CNA did not perform hand hygiene between glove changes or after completing perineal care, contrary to facility policy and infection control protocols. The CNA admitted to not sanitizing hands between glove changes and acknowledged that gloves were sometimes kept in her pocket due to glove size availability issues. The Director of Nursing confirmed that staff are expected to change gloves and perform hand hygiene to prevent infection, especially when moving from clean to dirty areas during care. The facility's perineal care policy, last revised in December 2011, outlines the steps for proper cleaning and hand hygiene, which were not followed during the observed incident.