Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Wound Care
Penalty
Summary
The facility failed to adhere to its infection control policies and procedures for Enhanced Barrier Precautions (EBP) during wound care for two residents with chronic wounds. The Treatment Nurse did not wear the required personal protective equipment, specifically a gown, while providing wound care to both residents. Additionally, there were no signs indicating EBP on the residents' room doors, and the nurse was uncertain about the necessity of EBP orders for these residents, despite their chronic wound status as defined by facility policy. During wound care for the first resident, who had a stage 2 pressure ulcer to the coccyx, the Treatment Nurse entered the room without a gown, washed her hands, donned gloves, and removed a soiled dressing. Without changing gloves or performing hand hygiene, she continued with wound cleansing and dressing application. Hand hygiene was only performed at the end of the procedure after glove removal. The nurse later stated she was unsure if the resident required EBP and was unclear about the hand hygiene protocol between glove changes. For the second resident, who had wounds on both ankles from a prior motor vehicle accident, the Treatment Nurse again did not wear a gown and failed to perform hand hygiene between glove changes and between wound care steps. She removed and reapplied gloves without hand hygiene and completed wound care on both ankles before washing her hands at the end. The nurse expressed uncertainty regarding the need for EBP and the specific hand hygiene requirements during wound care. The Director of Nursing, who also served as the Infection Preventionist, confirmed that EBP was only applied to residents with chronic wounds and was unsure if the residents in question met the criteria, further contributing to the deficiency.