Improper Perineal Care and Hand Hygiene During Incontinent Care
Penalty
Summary
The deficiency involves the facility’s failure to maintain proper infection prevention and control practices during incontinent perineal care for one resident. The resident was an elderly female with unspecified dementia, anxiety disorder, heart failure, moderate cognitive impairment (BIMS score of 9), and was always incontinent of bowel and bladder and dependent on staff for toileting hygiene. During an observed perineal care episode, CNA A unfastened the resident’s brief, had her roll toward another CNA, and wiped the resident’s buttocks using multiple passes with the same wipe. CNA A then threw the soiled wipes and the soiled brief onto the floor instead of into a designated container. Without changing gloves or performing hand hygiene, CNA A obtained and applied a clean brief, then picked up the soiled brief from the floor and placed it into a plastic bag provided by CNA B. CNA A later stated she had been checked off on perineal care only once in about a year of employment and acknowledged she should have cleaned the front perineal area first, wiped only once before changing the wipe surface, changed gloves, washed her hands between handling the soiled and clean briefs, and avoided placing the soiled brief on the floor. The facility’s written policies on perineal care and hand hygiene required front-to-back cleansing, not reusing the same side of disposable wipes, discarding disposable items into designated containers, removing gloves and discarding them appropriately, and performing hand hygiene before moving from a contaminated to a clean body site, which were not followed during this care episode.
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