Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During IV, Wound, and Colostomy Care
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program, specifically related to enhanced barrier precautions and hand hygiene for residents receiving IV therapy, wound care, and colostomy care. Facility policy on Enhanced Barrier Precautions required the use of gown and gloves for high-contact resident care activities such as device care (including central lines) and wound care. Policy on Handwashing/Hand Hygiene required hand hygiene before touching a resident, before aseptic tasks, after contact with blood or body fluids, after touching a resident or their environment, before moving from a soiled to a clean body site, and immediately after glove removal. Surveyors observed an LPN preparing and administering IV therapy to a resident with a PICC line without wearing a gown, despite the resident being on enhanced barrier precautions as indicated in the electronic medical record and by signage on the door. The LPN acknowledged awareness of the precautions and admitted she should have worn a gown. In another observation, a wound care LPN prepared a tray of wound care supplies while wearing gloves, then removed gauze, ABD pads, and a super-absorbent dressing from their packaging with ungloved hands. She then entered the resident’s room wearing a gown and gloves, packed the wounds, and did not change gloves or perform hand hygiene before applying the outer dressings. She later confirmed she had not worn gloves while preparing supplies and had not washed her hands or changed gloves after packing the wound. Additional deficiencies were identified during colostomy care for another resident under enhanced barrier precautions. An LPN confirmed he did not wear a gown while providing colostomy care, despite knowing the resident was on enhanced barrier precautions and acknowledging he should have worn a gown, mask, and gloves. He also admitted he did not change gloves or wash his hands after cleaning the colostomy site with soap and water and before cutting out the colostomy bag. A CNA involved in colostomy-related care confirmed she was not wearing a gown, could not recall the resident’s precautions, and acknowledged she should have worn a gown and gloves. She reported using wipes to clean the skin and wafer after removing the bag, stated she ran out of soap, and admitted she should not have used wipes to clean the area. Interviews with supervisory staff, including a unit manager, an LPN, and the DON, confirmed that residents with PICC lines, wounds, feeding tubes, catheters, and colostomies are under enhanced barrier precautions and that staff are required by facility policy to wear appropriate PPE and perform hand hygiene when transitioning from dirty to clean tasks.
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