Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Catheter Care
Penalty
Summary
Surveyors identified a deficiency in the facility’s provision of catheter care and adherence to Enhanced Barrier Precautions (EBP) and hand hygiene requirements for one resident with an indwelling urinary catheter. Facility policy on urinary catheter care required disposable one-time-use gloves when emptying urinary drainage bags and performing perineal care, and hand hygiene before and after touching any part of the urinary catheter drainage system. The EBP policy required gown and gloves for high-contact resident care activities, including medical device care and incontinent care, and specified that standard precautions must be followed with all care. The CNA job description required adherence to infection control and standard precaution practices when performing nursing procedures. The resident involved was an older adult with dementia, cognitive communication deficit, urinary retention, obstructive and reflux uropathy, and a history of UTI, with physician orders and a care plan in place for EBP related to an indwelling urinary catheter and for infection risk related to poor oral intake, dehydration, and weakened immune function. During an observation of catheter care, a CNA entered the resident’s room, applied gloves without performing hand hygiene, and did not don a gown despite the resident being on EBP for an indwelling catheter. Another CNA entered the room, assisted with repositioning the resident in bed, and did not wear gloves or a gown. The first CNA filled a washbasin with water and multiple washcloths, then used one washcloth to clean the resident’s penis, another to clean the scrotum, and another to clean the catheter tubing and catheter bag, all from the same basin. The CNA then changed gloves for the first time after completing this sequence of care but again did not perform hand hygiene, and proceeded to adjust the resident’s pants. When questioned, the CNA stated that a gown was not required for catheter care, which conflicted with the facility’s EBP policy and the resident’s orders and care plan for EBP and infection prevention measures.
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