Failure to Implement Appropriate Precautions and Hand Hygiene for Residents With RSV and Wounds
Penalty
Summary
The deficiency involves the facility’s failure to implement appropriate transmission-based precautions for residents with Respiratory Syncytial Virus (RSV) and coronavirus, and to follow CDC guidance and its own policies. Physician orders for two residents with RSV specified droplet precautions but did not include contact precautions, despite the facility’s RSV policy describing transmission via droplets and contaminated surfaces. Droplet isolation signs were posted on their doors, but one PPE container lacked gowns and there were no contact isolation signs. Staff, including CNAs and an OT, entered these rooms wearing only masks or masks and gloves, without gowns or eye protection, while providing direct care and assisting with mobility. One CNA delivered a meal tray, touched the overbed table, handled a used disposable cup, and exited the room without wearing gown, gloves, or eye protection and without discarding the mask upon exit. Staff interviews showed inconsistent understanding of required PPE, and the DON later stated that both droplet and contact precautions with full PPE should have been followed for RSV. The facility also failed to implement Enhanced Barrier Precautions (EBP) for a resident who developed multiple pressure ulcers. This resident had a facility-acquired unstageable pressure ulcer on the left ankle that progressed and was later reclassified as a stage four pressure ulcer requiring debridement, and also developed an unstageable pressure ulcer on the left heel. Despite the presence and progression of these open wounds, there was no documentation in the medical record that EBP had been initiated, and the DON confirmed there was no EBP order. A CNA who cared for the resident on the day of transfer to the hospital stated the resident was not on any precautions and gowns were not worn during care, contrary to CDC guidance and the DON’s statement that EBP is implemented for open wounds. In addition, the facility did not ensure adherence to its hand hygiene policy and EBP requirements during wound care for another resident with a stage four pressure ulcer, a PICC line, and an indwelling urinary catheter. This resident had an EBP order and signage on the door instructing staff to wear gown and gloves for high-contact care activities, including wound care. Two LPNs entered the room wearing only gloves, without gowns, and one LPN performed wound cleansing and dressing changes without a gown and without performing hand hygiene between dirty and clean steps of the procedure, changing gloves but not using hand sanitizer or washing hands. The LPN later confirmed not wearing a gown and not performing hand hygiene, believing it was only necessary when hands were visibly soiled, despite the facility’s policy requiring hand hygiene even when gloves are used and the DON’s expectation for hand hygiene with each glove change during wound care.
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