F0690

D

Improper Positioning and Sanitary Maintenance of Foley Catheter Drainage Bag

Kokomo, Indiana Survey Completed on 02-02-2026

Penalty

No penalty information released

Summary

Surveyors observed that a resident with a Foley catheter had the urinary drainage bag attached to a trash can next to the bed. The trash can contained trash in the bottom, and the urine in the catheter tubing was described as cloudy with sediment. The resident’s clinical record showed diagnoses including a history of UTI, acute kidney failure, anxiety disorder, chronic pain syndrome, hypertension, heart failure, COPD, urinary retention, and atrial fibrillation. The care plan indicated the resident had a Foley catheter related to neurogenic bladder, with interventions that included observing the catheter tubing.

A recent physician’s order documented that the resident was receiving ciprofloxacin 500 mg twice daily for 14 days for a UTI. Facility staff, including the ADON, Medical Record Nurse, and a QMA, each stated in interviews that the catheter bag should not be placed on a trash can and should instead be hung on the bed rail, and that placing the bag on the trash can put the resident at risk of infection. The facility’s urinary catheter care policy required checking urine for unusual appearance, keeping the drainage bag positioned lower than the bladder to prevent backflow, and ensuring the catheter and tubing were free of kinks, but did not direct staff to place the bag on a trash can.