Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Incontinence and G-Tube Care
Penalty
Summary
Surveyors identified a deficiency in the facility’s infection prevention and control program related to the care of one resident on Enhanced Barrier Precautions (EBP) for a G-tube and wounds. The resident was an elderly female with senile degeneration of the brain, gastrostomy status, and non-pressure chronic ulcers to both ankles, who was severely cognitively impaired, always incontinent of bowel and bladder, and dependent for toileting, showers, and transfers. Her care plan, initiated 07/18/24, documented that she was on EBP related to wounds and device care, with interventions requiring staff to wear clean gowns and gloves while performing high-contact care. On observation, a sign was posted outside her door indicating EBP, yet during incontinent care, an LVN and a CNA did not wear gowns as required. Further observation showed that after wiping the resident’s bottom during incontinence care, the LVN did not remove her soiled gloves or perform hand hygiene before reconnecting the resident’s G-tube feeding. In interviews, the LVN stated she had washed her hands before starting care and was not aware that a G-tube was considered an indwelling medical device requiring EBP, believing gowns were only needed if secretions were bloody and that EBP applied only to wounds and Foley catheters. She acknowledged the risk as contamination and stated she should have changed gloves before handling the feeding tube. The CNA reported she did not wear a gown because the nurse was not wearing one and she was unsure of the risk. The DON stated that EBP required staff to wear gloves and gowns while providing care and that the nurse should have changed gloves and performed hand hygiene before connecting the G-tube, identifying the risk as contamination and spread of infection. Facility policies on Standard and Enhanced Precautions and Implementation of Standard and Transmission-Based Precautions indicated that gowns and gloves are required for high-contact resident care activities for residents with wounds and/or indwelling medical devices, even if not known to be infected or colonized with MDROs.
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