Failure to Enforce Transmission-Based Precautions, Proper PPE Use, and Linen Handling
Penalty
Summary
The deficiency involves failures in the facility’s infection prevention and control practices related to transmission-based precautions, PPE use, and linen handling. One cognitively intact resident with MRSA of the nares was admitted with strict contact and droplet isolation orders requiring a single room, the resident to remain in the room, and all services to be done inside the room. The care plan and facility policies required contact and droplet precautions, including closed doors and use of appropriate PPE (mask, gown, gloves, face shield) by staff and visitors. Despite this, surveyors repeatedly observed the resident’s door wide open with posted contact and droplet precaution signage, and the resident’s significant other inside the room in close proximity to the resident without any PPE. The resident’s significant other reported that the door to the room was always wide open and that no one had told her she needed to wear PPE, stating that only therapists wore PPE and that nursing staff and meal delivery staff entered the room without PPE. She stated that the droplet precaution sign had only been posted for two days and that when she asked staff if the resident’s condition was contagious, she was told it was not, though she could not identify who said this. The DON stated that the family was non-compliant with PPE and that she believed she had educated the significant other about PPE and keeping the door closed, but initially could not recall if this was documented. A late-entry progress note later described the significant other as upset, refusing to wear mask and gloves, removing her gown, sitting next to the resident, and repeatedly opening the door after the DON closed it, while the DON continued to educate her about isolation and door closure. A second resident with COVID-19 and MRSA nares was on strict contact and droplet isolation with care plan approaches including contact, droplet, and airborne precautions. Surveyors observed the room door closed with appropriate signage, but later observed a CNA responding to this resident’s call light wearing only a standard surgical mask, gown, gloves, and face shield. After exiting the room and removing PPE, the CNA acknowledged awareness that the resident was on isolation for COVID-19 and stated she should have worn an N95 mask for her own protection. Additionally, surveyors observed two clean linen carts on the second floor with flaps open, exposing clean linen, contrary to the facility’s linen policy requiring clean linen to be kept covered on carts. The Infection Preventionist confirmed that PPE for COVID-19 residents should include a gown, N95 mask, face shield, and gloves, that MRSA nares required contact and droplet precautions from admission, and that linen cart flaps should always be closed to prevent spread of infection.
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