Failure to Implement Correct Isolation Precautions and Hand Hygiene for C. diff and Respiratory Infections
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control policies and CDC guidance for residents on isolation precautions for C. diff and respiratory infections. During an unannounced visit related to gastrointestinal and respiratory outbreaks, surveyors observed that staff did not consistently use appropriate PPE or perform required hand hygiene when entering and exiting rooms of residents on contact enteric precautions for C. diff. For one resident with C. diff, the Administrator and Social Services Director entered the room wearing only surgical masks, without donning the required gown and gloves indicated on the contact enteric signage posted at the door. Both staff members left the room without washing their hands, despite the sign instructing everyone to wash or gel hands when entering and wash on leaving the room. For another resident with C. diff, a staff member serving meals and coffee donned a mask, gown, and gloves before entering the room but removed the PPE and used only alcohol-based hand rub (ABHR) after exiting, without washing hands with soap and water as required by the facility’s C. diff and norovirus policies. The staff member also did not perform hand hygiene before donning PPE on re-entry. The Infection Preventionist confirmed that residents with C. diff are placed on contact enteric precautions and that staff should wear gown and gloves before entering and wash their hands after leaving the room, and that handwashing with soap and water is superior to ABHR for removal of C. diff spores. A physical therapist entering the room of a resident with C. diff wore appropriate PPE but, after removing it and exiting, used only ABHR and did not wash hands with soap and water before proceeding to another area. Additional deficiencies were identified in the accuracy of isolation signage for residents on transmission-based precautions. One resident with a diagnosis of human metapneumovirus had a physician’s order for strict single-room isolation with droplet precautions, but the door signage incorrectly indicated contact precautions for C. diff. Another resident with a positive C. diff laboratory result and an order for contact precautions had a sign that indicated contact precautions for C. diff/norovirus but instructed staff to use ABHR before entering and when leaving the room, rather than specifying handwashing with soap and water after leaving as required for contact enteric precautions. A further resident with a physician’s order for isolation with droplet precautions due to influenza had a door sign indicating Enhanced Barrier Precautions instead of droplet precautions. The Director of Nursing and Infection Preventionist acknowledged that the signage for these residents did not reflect the ordered type of isolation precautions. A certified nursing assistant assigned to the resident with metapneumovirus reported redirecting the resident from the hallway back into the room while wearing only an N95 mask and no gown or gloves, then donning PPE inside the room without performing hand hygiene beforehand. The CNA stated the resident was on contact precautions for C. diff based on the posted sign, even though the physician’s order and the Infection Preventionist’s review confirmed the resident was actually on droplet precautions for metapneumovirus. Review of facility policies on isolation, C. diff, norovirus, and influenza showed that the facility required appropriate signage at room entrances specifying the type of CDC precautions and PPE instructions, and required soap-and-water handwashing after care of residents with C. diff or norovirus. The observed practices and incorrect signage did not conform to these written policies and CDC guidance. These failures had the potential for the spread of communicable disease among residents, staff, and visitors.
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