Failure to Implement and Follow Infection Control Precautions
Penalty
Summary
A review of facility policy and clinical records revealed that residents with tracheostomies, hemodialysis, feeding tubes, and indwelling urinary catheters had physician orders and special instructions for enhanced barrier precautions, including the use of personal protective equipment (PPE) by staff. During a facility tour, it was observed that hand sanitizing dispensers near several resident rooms were empty, and a public restroom lacked soap and paper towels. These deficiencies in infection control supplies were confirmed by facility staff. Additionally, direct observations showed that a dialysis patient care technician provided bedside dialysis to a resident with a tracheostomy and hemodialysis without wearing the required PPE. Similarly, a licensed nurse was observed providing care to a resident with a feeding tube and indwelling urinary catheter, also without appropriate PPE. Both staff members acknowledged the failure to follow PPE protocols, and these lapses were confirmed by the Assistant Director of Nursing and Infection Preventionist.