Failure to Implement Enhanced Barrier Precautions During Resident Care
Penalty
Summary
The facility failed to ensure that enhanced barrier precautions (EBP) were properly implemented during wound and catheter care for two residents who required these precautions. Observations revealed that an LPN performed wound care on a resident's left lower leg and subsequent incontinent care without wearing a gown, as required by the facility's EBP policy. The LPN also used soiled gloves to apply cream to open wounds on the resident's buttocks after providing incontinent care, further deviating from proper infection control practices. The resident had chronic venous hypertension with ulcers on both lower legs and stage 2 pressure ulcers on the buttocks, with care plans and physician orders indicating the need for EBP. Additionally, two CNAs provided catheter care to another resident with an indwelling catheter for comfort measures, also without wearing gowns as mandated by the EBP policy. Both CNAs stated they understood and followed EBP protocols, despite not adhering to the required use of gowns during high-contact care activities. The ADON reported that staff had been educated on EBP practices, but the observed actions did not align with facility policy or training.