Failure to Follow Droplet and Enhanced Barrier Precautions During Resident Care
Penalty
Summary
The deficiency involves failures in the facility’s infection prevention and control practices related to Droplet Precautions and Enhanced Barrier Precautions (EBP). A resident with an active order for Droplet Isolation Precautions for RSV had a Droplet Precautions sign posted on the room door instructing everyone to clean their hands and ensure eyes, nose, and mouth were fully covered before entry, and to remove face protection before exit. Despite this, a GNA entered the resident’s room to remove a meal tray wearing only a mask and no gown or additional required PPE. In an interview immediately afterward, the GNA acknowledged knowing the resident was on Droplet Precautions but stated she did not know a gown was required unless performing direct care such as washing the resident, and she was unsure if there was a designated Infection Preventionist. The deficiency also includes improper infection control technique during wound care for a resident on EBP for a coccyx wound. EBP signage on the door indicated staff must wear gowns and gloves during high-contact care activities. During an observed dressing change, an LPN placed two pairs of gloves on their hands, entered the room, removed the old dressing, cleansed the wound, then removed only the top pair of gloves and proceeded to apply the new dressing without performing hand hygiene or changing to a completely new single pair of gloves as described by facility leadership. The resident’s medical record confirmed an order for EBP every shift and specified the wound care steps, including cleansing the coccyx cluster and applying santyl, calcium alginate, barrier cream to the periwound, and covering with bordered foam daily and as needed.
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