Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During High-Contact Care
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program, specifically enhanced barrier precautions (EBP) and hand hygiene, during high-contact resident care activities. For one resident with hemiplegia, multiple contractures, sacral pressure ulcer, total dependence for toileting, and continuous incontinence, the care plan required EBP due to open wounds. During observed incontinence care, two CNAs did not wear isolation gowns despite an EBP sign on the door instructing staff to wear gowns and gloves for activities such as changing linens, providing hygiene, and changing briefs. Their shirts came into direct contact with the resident and linens, and both CNAs confirmed they did not don gowns while providing incontinence care or changing soiled linens. Another resident with multiple sclerosis, paraplegia, pressure ulcers including stage 2 and stage 3 wounds, an indwelling medical device, feeding tube, ostomy, and open wounds had a care plan requiring EBP. The plan specified use of gown and gloves during high-contact care such as dressing, bathing, transferring, hygiene, linen and brief changes, toileting, device care, and wound care. During an observed wound care procedure to this resident’s left knee, a hospice RN and hospice aide provided care without wearing isolation gowns, and an LPN was present in the room. Both hospice staff confirmed they did not wear gowns during the wound care and also confirmed they provided care to multiple other residents in the facility that day. The DON later confirmed hospice staff were expected to follow the facility’s infection control practices, including proper PPE use. A third resident with hemiplegia, contractures, protein-calorie malnutrition, multiple pressure ulcers (including stage 3 and unstageable ulcers), bed confinement, an indwelling catheter, total incontinence, and total dependence for ADLs had a care plan requiring EBP during high-contact care due to open wounds and osteomyelitis. Interventions included use of PPE (gown and gloves, face shield as indicated) for activities such as dressing, bathing, transferring, hygiene, linen and brief changes, toileting assistance, device care, and wound care. During an observation of turning and repositioning in bed, an LPN adjusted the resident’s pillows, linens, and blankets without donning an isolation gown, and the resident and linens frequently contacted the LPN’s shirt. The LPN did not perform hand hygiene before providing care or after completing care and before leaving the room, despite an EBP sign on the door instructing everyone to clean their hands before entering and when leaving, and to wear gloves and a gown when transferring. Review of facility policies confirmed that hand hygiene is required immediately before and after touching a resident or the resident’s environment, and that EBP requires gown and gloves for specified high-contact care activities for residents with wounds or indwelling devices.
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