Infection Control Failures in Catheter Care, Equipment Maintenance, and Enhanced Barrier Precautions
Penalty
Summary
The deficiency involves failures in the facility’s infection prevention and control practices related to indwelling catheter management, equipment maintenance, and adherence to Enhanced Barrier Precautions (EBP). Surveyors observed a resident with chronic kidney disease, neurogenic bladder, paraplegia, and an indwelling catheter whose drainage bag was hanging on a wall hook with the catheter tubing lying across the top of the resident’s trashcan on two consecutive days. The resident’s care plan directed staff to check the tubing for kinks and keep the bag lower than the bladder, but did not address securing the tubing away from contaminated surfaces. Staff interviews revealed inconsistent understanding of whether it was acceptable to use a trashcan to keep catheter tubing off the floor, with some CNAs stating it was not acceptable and a CMA stating it was acceptable. A second deficiency was identified in the maintenance of housekeeping equipment. A housekeeper was observed using a housekeeping cart that had silver duct tape lining both sides of the top rolling door and the back access door. The tape was not fully affixed, leaving exposed adhesive that could harbor bacteria. The housekeeper reported the cart was new but had broken about a month earlier. The Environmental Services Director stated that housekeeping staff report repair needs to him and that equipment is replaced when damaged, and he acknowledged he was aware of the taped cart but did not realize the tape was being used as a repair method. A third deficiency involved failure to follow EBP requirements for a resident with chronic kidney disease, non-Alzheimer’s dementia, heart failure, diabetes, and a chronic right foot ulcer who required EBP due to wounds. An in-home nurse entered the resident’s room, removed the right foot dressings, and took pictures of the wound without wearing a gown, despite an active physician’s order for EBP and a posted EBP sign at the door specifying that gloves and a gown must be worn for wound care and other high-contact care activities. The nurse acknowledged receiving infection prevention education, noticed the resident was on EBP, and admitted he did not refer to the posted sign and refused to don a gown when prompted because he believed he was already finished in the room. During this interaction, he also held the resident’s drinking cup with the same gloved hands used for wound care.
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