Improper Perineal Care and Infection Control During Incontinence Care
Penalty
Summary
Failure to provide sanitary perineal care occurred when a nurse did not follow infection prevention and control practices while cleaning a resident with loose stool and a history of a sacral pressure ulcer. The facility’s perineal care policy stated that dependent patients should receive cleansing of the perineum following voiding or defecation to promote healing and comfort. The resident involved had diagnoses including Alzheimer’s disease, heart failure, rhabdomyolysis, cerebral infarction, and hemiplegia/hemiparesis, and was assessed as having moderate cognitive impairment and dependence with toileting hygiene. The resident had a history of a sacral pressure ulcer that had been documented as resolving and then closed on weekly skin assessments. During an observation, an LPN entered the resident’s room, which had an enhanced barrier sign posted and an infection control PPE container on the door that contained only a partially filled bottle of hand sanitizer and no gowns. The resident was lying on an airflow mattress with loose stool between her thighs that had leaked from her brief. The LPN did not don a protective gown despite the presence of loose stool and proceeded to roll the soiled brief toward the back and begin cleaning the front perineal area. After turning the resident to her side, the LPN removed the rolled brief, used a clean wipe to clean the buttocks and sacral area, then used another wipe to clean between the thighs where loose stool had settled, and with that same soiled wipe wiped again over the buttocks and sacral area. In a subsequent interview, the LPN acknowledged that she did not have a bag for dirty items, confirmed she had wiped a clean area with a dirty wipe, did not re-clean the sacral and buttock area, and admitted she did not perform the procedure correctly and did not wear a gown as she was supposed to.
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