Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Device and Incontinence Care
Penalty
Summary
Surveyors identified that nursing staff did not follow the facility’s Enhanced Barrier Precautions (EBP) and PPE requirements when providing care to multiple residents with devices and wounds. One RN administered an enteral feeding via gastrostomy tube (g-tube) to a resident who had an EBP sign on the door and a care plan requiring EBP due to a g-tube, urinary catheter, and wound, but the RN wore only gloves. The same RN later assessed and flushed another resident’s g-tube, again with an EBP sign posted and a care plan requiring EBP for a g-tube and wound, while wearing only gloves. An LPN administered a bolus g-tube feeding to a third resident whose door displayed an EBP sign and whose care plan required EBP due to a g-tube, but the LPN also wore only gloves. The facility’s EBP policy required gown and gloves for high-contact resident care activities, including handling feeding tubes, and the DON stated staff were expected to adhere to EBP when rendering direct care. Surveyors also observed a CNA providing incontinence care to another resident without performing hand hygiene and while improperly using gloves and contaminated supplies. The CNA entered the room, closed the door, and donned gloves without hand hygiene, then removed a urine- and stool-soiled undergarment, turned off the call light with soiled gloves, and closed the privacy curtain, bumping the overbed table and knocking the roommate’s stuffed bear to the floor. The CNA picked up the bear with the same soiled gloves and then continued incontinence care, wiping under the resident’s reddened abdominal fold and vaginal area multiple times with the same towel, and wiping the buttocks and gluteal cleft multiple times with the same washcloth, before covering the resident, removing gloves, and leaving the room. The DON stated that not cleaning residents properly during incontinence care and touching environmental items with soiled gloves is an infection control concern and that staff should perform proper hand hygiene. Facility policies on incontinence care and hand hygiene required perineal/genital care to prevent infection and specified handwashing or alcohol-based hand rub use before and after glove use, after handling potentially contaminated items, and after direct resident care.
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