Failure to Follow Contact Precautions for Suspected C. diff Room
Penalty
Summary
The deficiency involves the facility’s failure to consistently implement its infection prevention and control measures for contact precautions in a room under investigation for Clostridioides difficile (C. diff). The facility’s Transmission-based Precautions and Isolation Procedures policy required staff to don appropriate PPE, including gown and gloves, before or upon entering a room on contact precautions and to perform hand hygiene prior to leaving the room. A contact precaution sign posted on a resident room door instructed everyone to clean their hands with soap and water before entering and leaving the room, and to put on gloves and a gown before room entry and discard them before room exit. One resident in the bed near the window in that room had complaints of diarrhea and was suspected of having C. diff, and the contact precaution signage had been posted for that reason. During observation, a Registered Nurse/Unit Care Coordinator (Staff D) entered this contact precaution room without washing hands or donning a gown and gloves, spoke with the resident in the bed near the window who reported dizziness and diarrhea, then spoke with the resident in the bed closest to the door, and exited the room without performing hand hygiene with soap and water. Staff D then obtained a straw from the medication cart, re-entered the same room again without hand hygiene or PPE, unwrapped the straw for the resident closest to the door, picked up that resident’s breakfast tray, exited the room with the tray, and placed it on a tray cart in the hall near the kitchen. Staff D then proceeded toward the employee lounge, stating they needed to wash their hands, and entered the lounge without having washed their hands with soap and water during the entire observation. In interviews, Staff D acknowledged the posted precautions applied to all staff and that they should have followed the instructions. The Infection Preventionist, the Interim DON, and the Administrator each stated that contact precautions required gown and gloves before room entry, removal of PPE before exit, and handwashing with soap and water when C. diff was suspected, and that all staff were expected to follow the posted precaution signs. The report states this is a repeat deficiency under WAC 388-97-1320(1)(c)(2)(a) from prior Statements of Deficiencies.
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