Failure to Follow Enhanced Barrier Precautions and Hand Hygiene Practices
Penalty
Summary
The deficiency involves failures to adhere to infection prevention and control protocols for residents on Enhanced Barrier Precautions. For one resident admitted with a malfunctioning tracheostomy and neuromuscular bladder dysfunction, physician orders specified Enhanced Barrier Precautions for carbapenem-resistant Acinetobacter baumannii, with a catheter and gastrostomy tube in place. During observation, this resident’s Foley catheter bag was seen resting on the floor next to the bed. A CNA confirmed that the Foley bag should have been hung on the bed frame and stated it was not supposed to be on the floor because it was contaminated. The DSD also stated the Foley bag should never be on the floor for infection control. The facility’s IPCP Standard and Transmission-Based Precautions policy did not provide guidance on Foley catheter bag placement. A second deficiency involved handling of soiled linen and trash for a resident admitted with ventilator dependence and a gastrostomy, who had physician orders for Enhanced Barrier Precautions due to tracheostomy and G-tube placement. A CNA was observed doffing PPE inside the resident’s room, then donning a new pair of gloves and taking a clear plastic trash bag into the hallway. In the hallway, the CNA opened the bag and separated its contents, placing soiled linen into a gray bin and trash into a white bin. The CNA stated she had provided peri-care and separated the resident’s soiled briefs and dirty linens in the hallway because she only had one trash bag. The DSD stated this was not proper infection control, indicating the soiled linen and trash should have been placed in two separate bags inside the resident’s room and that the CNA should have performed hand hygiene after doffing PPE and before leaving the room. The DON stated she expected staff to contain soiled linen and trash inside the resident’s room and that separating them in the hallway could spread bacteria throughout the facility. The facility’s IPCP policy stated all linen should be handled as if highly infectious. A third deficiency involved hand hygiene for a resident admitted with ventilator dependence and care-planned for carbapenem-resistant Acinetobacter baumannii, with instructions to maintain standard precautions. The Maintenance Supervisor was observed entering this resident’s room without performing hand hygiene and replacing the resident’s hospital bed control, a high-contact device used to adjust the bed. The Maintenance Supervisor later stated that, although he was not providing resident care, he should have performed hand hygiene before entering and exiting the room, especially after touching high-contact areas such as bed controls and side rails. The DSD stated the Maintenance Supervisor should have performed hand hygiene before exiting the room and that it was her expectation for staff to perform hand hygiene before exiting any resident’s room, particularly after touching high-contact areas. The DON stated she expected staff to perform hand hygiene before entering and prior to exiting resident rooms to prevent the spread of germs. The facility’s hand washing policy stated it was the facility’s policy to cleanse hands to prevent transmission of possible infectious material and to provide a clean, healthy environment for residents and staff.
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