Failure to Follow Contact Isolation and Enhanced Barrier Precaution Policies
Penalty
Summary
The deficiency involves the facility’s failure to follow its infection prevention and control policies for contact isolation and Enhanced Barrier Precautions (EBP). One resident with a known history of Clostridium difficile (C. diff) infection was not placed on contact precautions despite having loose bowel movements and receiving Vancomycin for a gastrointestinal issue. On multiple observations, there was no EBP or contact isolation signage on or outside this resident’s room, and no PPE bin was present outside the room. A registered nurse was observed in the room without PPE and stated the resident was not on isolation, even though the resident’s medication administration record showed ongoing Vancomycin therapy and the physician order sheet documented Firvanq for a history of C. diff. The Assistant DON/Infection Preventionist later stated that contact isolation orders for this resident had been discontinued when loose bowel movements had stopped, but that the resident began having loose bowel movements again on subsequent days. The Infection Preventionist acknowledged that the infectious disease nurse practitioner (ID NP) should have been notified when the loose bowel movements resumed so that contact isolation could be reinstated. The ID NP confirmed the resident’s history of C. diff and current Vancomycin treatment and stated he had not been informed of the recent loose bowel movements. He stated that the resident should have been placed back on contact isolation when the loose bowel movements began, consistent with the facility’s Clostridium Difficile Policy, which requires residents with diarrhea associated with C. difficile to be placed on contact precautions. The deficiency also includes the facility’s failure to implement its own EBP policy for multiple residents identified on the facility’s EBP list. For 16 residents on EBP for conditions such as wounds, indwelling urinary catheters, central lines, PEG tubes, and IV access, surveyors observed that EBP signage and PPE bins were placed inside the residents’ rooms rather than on the door or wall outside the room, contrary to facility policy and CDC guidance. Additionally, none of these residents had physician orders for EBP documented on their physician order sheets, despite being listed by the facility as on EBP. Staff interviews revealed inconsistent understanding of where EBP signage and PPE bins should be located, with some nurses stating they should be at the door and others explaining they were placed inside the room so staff could distinguish EBP from contact precautions. The Infection Preventionist confirmed that the facility did not obtain orders for EBP and that signage and PPE bins were intentionally placed inside rooms, even though the written EBP policy required signs and PPE to be posted and available outside resident rooms.
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