Improper Perineal Care Technique During Assisted Toileting
Penalty
Summary
A deficiency occurred when a nurse aide provided perineal care that did not follow infection control standards for wiping direction and use of clean surfaces. The resident involved had a fractured left femur, Alzheimer's disease, and was severely cognitively impaired per a recent MDS, requiring substantial to maximum assistance with toileting hygiene and setup/cleanup assistance with personal hygiene. Her care plan identified an ADL self-care deficit with an intervention for assistance with toileting and dressing as needed. During an observed toileting episode after urination and a bowel movement, the aide first wiped the resident’s anal area with a disposable wipe in an upward motion toward the back, then continued to wipe the anal area three times in an up-and-down motion without turning to a clean area of the wipe after each pass. The aide then changed gloves, moved in front of the resident, and performed perineal care to the vaginal area by reaching between the resident’s legs and wiping from the anal area toward the vaginal area, repeating this motion with a clean area of the same wipe from the anal area forward toward the vaginal area. In subsequent interviews, the aide stated she was familiar with the resident’s toileting needs, acknowledged that usual perineal care practice was to clean the vaginal area first and then the anal area using a clean side of the wipe each time, and stated she knew not to wipe from the anal area toward the vaginal area. She attributed her actions during the observation to difficulty seeing due to the resident’s leaning position, nervousness, and rushing. The nurse mentor and DON both confirmed that facility training and standard practice were to wipe the vaginal area front to back, then the anal area front to back, using a clean surface of the cloth for each wipe, and that proper perineal care was considered an infection control measure to help prevent urinary tract infections.
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