Failure to Follow Enhanced Barrier Precautions During High-Contact Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure staff consistently followed Enhanced Barrier Precautions (EBP) for high-contact resident care activities as ordered and as required by facility policy and CDC guidance. For one resident with multiple sclerosis, morbid obesity, a stage four pressure ulcer, and an open wound to the left lower leg, physician orders required EBP with PPE during high-contact care, including wound care. During an observed dressing change, the LPN entered the room with wound supplies, placed them on a clean bedside table, washed his hands, and began wound care wearing only gloves and no gown, despite the wound care being considered high-contact care under EBP. The LPN later acknowledged that a gown had been required for this high-contact wound care activity. Another resident with neuromuscular dysfunction of the bladder and an indwelling urinary catheter had an EBP order related to the catheter. An LPN was observed repositioning this resident in bed without wearing a gown, even though an EBP sign on the cart at the doorway specified that a gown should be worn for high-contact activities, including repositioning; the LPN confirmed a gown should have been worn. A third resident with dysphagia and a G-tube had an EBP order related to the G-tube. An LPN entered the room to administer medications via the G-tube and did not don a gown before performing this high-contact care activity, later confirming that a gown should have been worn. The facility’s infection preventionist stated that getting staff to follow EBP was an ongoing issue, despite her providing consistent reminders when on the floor.
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