Failure to Implement Transmission-Based Precautions and Scabies Testing
Penalty
Summary
The facility failed to implement transmission-based precautions and conduct appropriate testing for scabies for two residents who exhibited symptoms consistent with a possible infestation. According to the facility's own policy, residents with signs and symptoms of scabies, such as itching and rash, should be assessed, isolated, and tested to prevent further transmission. However, despite multiple documented instances of residents presenting with generalized itching, rashes, and excoriations, there were no physician orders for skin scrapings to rule out scabies, nor were contact precautions initiated for these residents. Resident records revealed that one resident had a persistent, generalized rash with linear excoriations and continued to scratch, resulting in bedding stained with blood. Another resident reported itching and developed a rash on multiple body areas, with no evidence of diagnostic testing for scabies being performed, despite being told it would be. Both residents were observed in shared rooms without any contact isolation signage or precautions in place, and staff interviews confirmed ongoing concerns about scabies and the lack of appropriate interventions. The infection preventionist acknowledged a previous outbreak of scabies in the facility and confirmed that while some residents had been treated, others with symptoms were not tested or placed on precautions. Staff interviews further indicated awareness of the symptoms and concerns about scabies, but there was a lack of follow-through in implementing the facility's infection control policy. The deficiency was identified through review of records, staff and resident interviews, and direct observation during the facility tour.