F0880

E

Failure to Implement Effective Scabies Treatment and Transmission-Based Precautions

Bradenton, Florida Survey Completed on 02-07-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to implement and maintain an effective infection prevention and control program, specifically in the management of scabies treatment and the use of transmission-based precautions and PPE. One resident with a dermatology-confirmed need for scabies treatment had handwritten dermatologist instructions dated 2/4/26 directing treatment for scabies with Permethrin 5% cream, to be applied from neck down overnight and repeated in one week, with isolation from other residents until the second treatment was completed. However, the physician orders in the facility record instead reflected an order for oral Ivermectin 3 mg tablets, three tablets by mouth once daily for five days for crusted dermatitis, starting 2/5/26. The MAR showed the first Ivermectin dose scheduled for 2/5/26 at 9:00 a.m. with subsequent doses scheduled every five days rather than daily, and the first dose was not administered, documented with a code indicating the medication was awaiting delivery. Staff interviews confirmed that the missed dose was not rescheduled, meaning the resident would receive only four of the five ordered doses. Pharmacy delivery schedules indicated the medication, ordered at 9:54 p.m. on 2/4/26, should have been available in the early morning delivery window on 2/5/26.

The facility’s own scabies management policy, effective August 2025, required implementation of contact precautions when scabies was suspected, use of gowns and gloves during close contact, obtaining and applying ordered treatment as directed, maintaining contact precautions and encouraging the resident to remain in the room for 24 hours post-treatment, and retreatment one week later. The policy also noted that symptoms may take weeks to develop and that transmission between treatments is possible. Despite this, the resident’s room was posted with Enhanced Barrier Precautions signage rather than clear contact precautions, and the treatment regimen ordered and scheduled did not align with the dermatologist’s written instructions for Permethrin topical therapy and repeat treatment in one week. Staff interviews revealed confusion about medication availability from the emergency drug kit and the process for handling unavailable medications, as well as differing understandings of pharmacy delivery times.

Additional deficiencies were identified in the implementation of transmission-based precautions and PPE availability for other residents on precautions. Observations on 2/7/26 showed rooms posted with both Contact and Enhanced Barrier Precautions signs without PPE stored at the entrance. An LPN could not locate orders supporting contact precautions for two residents and was unsure about the posted precautions, while the CNA assigned to those residents did not know why they were on contact precautions. Another observation found the Activity Director entering and having direct contact with a resident in a room posted for contact precautions without wearing any PPE; PPE was not available outside the room, and the Activity Director initially believed only hand hygiene was required when not providing hands-on care. After re-reading the sign, the Activity Director acknowledged that gown and gloves should have been worn. The DON and RN later confirmed that staff should wear PPE when entering rooms posted for contact precautions, that PPE should be placed outside such rooms, and that nurses should know what type of precautions residents are on. A CNA interview also showed misunderstanding of the differences between Enhanced Barrier Precautions and Contact Precautions, including incorrect statements about required PPE components.