Failure to Follow Enhanced Barrier Precautions During High-Contact Care
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective infection prevention and control program for a resident on Enhanced Barrier Precautions (EBP). The resident was admitted with multiple diagnoses including malnutrition, cerebral infarction with resulting dysphagia, cognitive communication deficit, hemiplegia/hemiparesis, and required a feeding tube. The admission MDS showed the resident was severely cognitively impaired and totally dependent for all ADLs, including toileting and personal hygiene. The care plan documented that the resident had impaired communication related to CVA and other neurological and functional deficits, required one to two persons for toileting and hygiene, and was on EBP due to an indwelling medical device, with an intervention directing staff to don gown and gloves during high-contact personal care activities. On the survey date, a CNA exited the resident’s room after providing peri-care and was observed not wearing gloves, a mask, or a gown, despite an EBP sign posted at the door instructing staff to wear gloves, gown, and mask for high-contact personal care. The resident was observed in bed wearing a brief and connected to a G-tube. In interview, the CNA stated she had been changing the resident and acknowledged she was not wearing PPE. She reported there was no PPE in the room, in the caddy on the door, or in nearby door caddies, and admitted she did not inform any nurse or look for PPE on other halls or in the storage closet. She further stated she should have been wearing PPE while providing direct care and because the resident had a PEG-tube. Additional interviews and observations showed that HR/Central Supply staff had been ordering PPE weekly for about two years, with deliveries the next day, and that there was no central storage room but supply closets on three halls, including the resident’s hall. Observation of the supply closet on that hall revealed available PPE, including gowns, masks, and gloves. HR staff stated that floor staff and resident ambassadors were responsible for restocking PPE caddies on doors of residents on EBP. The ADON, who served as the infection preventionist, reported she had recently restocked PPE caddies after the DON noted they were low, and she acknowledged some caddies had been empty or had only a few gowns. The DON stated that residents were placed on EBP for indwelling medical devices or open wounds, that signs and PPE caddies were placed at their doors, and that staff were expected to wear gloves and gowns to minimize infection spread. The facility’s written EBP policy required gowns and gloves to be made available immediately near or outside the resident’s room for residents with wounds or indwelling medical devices, such as feeding tubes.
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