Failure to Implement Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program by not using enhanced barrier precautions during wound care for two residents. On 01/14/26 at 9:05 a.m., LPN #3 provided wound care to Resident #49 after gathering supplies and entering the resident’s room. LPN #3 donned gloves but did not don a gown, despite the facility’s undated Enhanced Barrier Precautions policy stating that providers and staff must wear gloves and a gown for high-contact resident care activities, including wound care for any skin opening requiring a dressing. Resident #49’s annual assessment dated 12/17/25 showed severe impairment in daily decision making, memory problems, and diagnoses including dementia, depressive disorder, anxiety disorder, chronic pain, and a disorder of the skin and subcutaneous tissue. A physician order dated 01/02/26 directed Betadine application to both heels and specific wound care to the right buttock involving cleansing, application of Santyl or Anasept, calcium alginate, and bordered gauze until resolved. On 01/14/26 at 9:30 a.m., LPN #3 was again observed providing wound care, this time to Resident #75, and similarly donned only gloves without a gown. Resident #75’s annual assessment dated 11/22/25 showed no cognitive impairment with a BIMS score of 14 and diagnoses including congestive heart failure, anxiety disorder, pain, and an open wound of the left buttock, with no pressure ulcers noted. A physician order dated 01/12/26 directed cleansing of the left buttock wound, patting dry, and applying Medihoney and calcium alginate, then covering with bordered gauze once daily and as needed. During an interview at 9:37 a.m., LPN #3 stated that PPE such as gowns and face shields were needed only if a resident had hepatitis C or an active infection and that only gloves were needed for wound care. At 9:40 a.m., the DON stated that enhanced barrier precautions were used when a resident had an active infection, indicating facility practice inconsistent with the written Enhanced Barrier Precautions policy requiring gown and gloves for wound care as a high-contact activity.
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