Resident with Respiratory Virus Omitted from Outbreak Line List
Penalty
Summary
The facility failed to ensure accurate data collection during a respiratory illness outbreak by not including one resident in the outbreak line list. The resident was admitted with diagnoses that included chronic obstructive pulmonary disease with acute exacerbation. A Change in Condition Evaluation documented that the resident experienced shortness of breath and was transferred to the hospital for evaluation. Laboratory results dated the same day showed the resident tested positive for Coronavirus OC43, a common human coronavirus that usually causes mild to moderate upper-respiratory tract illness. During interviews and concurrent record reviews with the LVN/Infection Preventionist, it was confirmed that a respiratory illness outbreak had started earlier that month and that the facility was using a line list as an infection control tracking tool to collect data and actively monitor residents and staff during the suspected outbreak. The LVN/Infection Preventionist reviewed the line list and acknowledged that the resident who tested positive for a respiratory illness was not included, and stated that the resident should have been listed. The facility’s Infection Prevention and Control Program policy required the facility to identify, investigate, control, and prevent infections, maintain records of incidents and corrective actions related to infections, and required the Infection Preventionist to collect, analyze, and provide infection data and trends, which was not fully carried out in this instance.
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