Failure to Follow Infection Control Practices During Incontinence Care
Penalty
Summary
Staff failed to follow infection control practices during incontinence care for two residents. For one resident who required partial/moderate assistance with toileting and was incontinent of bowel and bladder, a CNA used the same section of a washcloth to wipe multiple areas of the perineum, contrary to facility policy and training, which require using a different part of the washcloth for each stroke. Both the LPN and Assistant Director of Nursing confirmed that this practice could lead to infection, and the CNA acknowledged not following the correct procedure during care. For another resident who required substantial assistance with toileting and was also incontinent, a CNA did not change gloves after cleaning a bowel movement and before applying barrier ointment to the perineum. Facility policy and staff interviews confirmed that gloves should be changed and hand hygiene performed when moving from a contaminated to a clean area. The CNA admitted to not changing gloves, recognizing that this could transfer bacteria and cause infections.