Failure to Follow Incontinence Care and Hand Hygiene Standards
Penalty
Summary
The deficiency involves failure to provide incontinence care and perineal care according to current standards of practice, including hand hygiene and skin protection, for two residents who were incontinent of bowel and bladder. One resident, admitted with morbid obesity, unsteadiness on feet, heart disease, and osteoarthritis, was documented on the MDS as cognitively intact and occasionally incontinent of bowel and bladder, with a care plan directing staff to apply barrier cream after each incontinent episode and to check and change every 2–3 hours and as needed. During observed peri care, the CNA removed a saturated incontinence brief and cleansed the resident’s penis, groin, and scrotum using washcloths with warm water and no-rinse peri solution, wiping up and down and at times using the same side of the cloth on different areas. The CNA changed gloves between cleaning the groin/penis and buttocks and again before drying, but did not perform hand hygiene between glove changes. The resident’s buttocks, scrotum, and upper thighs were red, irritated, and had open bleeding spots; the resident reported that cream was applied at times but was unsure how often. The ADON/wound nurse, when called to assess, identified the condition as moisture associated skin damage (MASD) and stated this was the first time she was aware of it, and the resident’s nurse also reported not being aware of the MASD, despite an existing order for cream twice daily to prevent further skin breakdown. The second resident, admitted with acute pyelonephritis, heart failure, hypertension, respiratory failure, joint stiffness, and scoliosis, was documented as cognitively intact, always incontinent of bowel and bladder, and dependent on staff for toileting. The care plan for this resident included interventions to apply barrier cream after each incontinent episode and to clean the peri area with each incontinent episode. During observed incontinence care, the CNA changed gloves after cleaning the peri area, after cleaning the buttocks, and after drying, but did not perform hand hygiene after removing soiled gloves or before donning clean gloves. Both CNAs later stated they did not hand sanitize between glove changes because they forgot. The facility’s Hand-Washing/Hand Hygiene Policy requires use of alcohol-based hand rub before and after putting on and upon removal of PPE, including gloves, when hands are not visibly soiled, and the ADON stated she would expect staff to hand sanitize between glove changes.
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