Failure to Implement Effective Scabies Infection Prevention and Control Measures
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective infection prevention and control program during a scabies outbreak. One resident had weekly skin assessments documenting a rash over several months, and physician orders were written for ivermectin on two specific dates to treat scabies. A nursing progress note indicated the pharmacy was contacted and would send the medication, but the medical record contained no documentation that the ivermectin was ever administered. The same resident was to be added to a dermatology consult list and later had a physician order for a dermatology consultation for a rash on the back and upper arms, yet there was no evidence in the record that the dermatology consultation occurred. During a side‑by‑side record review, the Infection Control Preventionist (ICP) agreed with these findings. The facility also failed to implement timely and consistent contact precautions for multiple residents treated for scabies, contrary to its policy requiring contact precautions prior to and during treatment. One resident received multiple courses of permethrin cream and ivermectin over several months; contact precautions were documented only for an initial period and then were absent for an extended interval despite ongoing treatment. Another resident received permethrin cream and ivermectin with no documented contact precautions at any time during treatment. A third resident, who reported having a rash that began at the facility and being treated on and off for a few months, had intermittent contact precautions that were delayed several days after initiation of treatment on more than one occasion. The ICP stated that contact precautions should begin with suspicion or treatment of scabies and noted that the onsite dermatologist sometimes ordered permethrin directly from the pharmacy without prior notification to the ICP. The infection surveillance and environmental control components of the program were also deficient. The facility reported a rash/scabies outbreak to the State Agency and maintained a log of residents with itchy rashes, but the corresponding Infection Surveillance Line Listing Report omitted most of those residents, including several identified in October and two in November, even though the ICP acknowledged the log was used to track and trend infections. Environmental services policies required bagging linens, towels, washcloths, lift slings, and clothing from the preceding three days, specific laundering or maintenance procedures, and thorough vacuuming of mattresses for residents treated for scabies. However, documentation provided for the affected unit during the outbreak showed only routine cleaning schedules and terminal cleaning checklists that lacked room numbers and did not reference bagging of linens or personal items or mattress vacuuming, and the Director of Environmental Services agreed with these findings. Additionally, although the ICP stated that staff education on scabies was ongoing and had been provided during the outbreak, the only documented trainings related to scabies were dated in December and January, with no evidence of staff education in October or November during the period of the outbreak.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.