Failure to Implement Scabies Surveillance and Contact Precautions
Penalty
Summary
Surveyors identified a deficiency in the facility’s infection prevention and control program related to the management of scabies. The facility’s policies required surveillance, documentation of suspected and confirmed infections, and implementation of contact precautions for transmissible conditions such as scabies and rash of unknown origin. Despite this, the Infection Surveillance Report from January 1, 2026, through March 24, 2026, documented no parasitic or skin infections, even though multiple residents had physician orders for antiparasitic topical medication (Permethrin) for Sarcoptes scabiei. The report only partially noted three residents as having been treated with antiparasitic medication without marking the parasite option, and it omitted several other residents who were treated for scabies during February and March. For one resident with extensive symptoms, documentation showed an itchy rash over most of the body, a request for dermatology referral, and a weekly skin observation noting a new rash over the body with physician notification. The medical director’s nurse stated that the medical director diagnosed this resident with scabies and ordered antiparasitic cream. The treatment administration record showed the antiparasitic medication was applied, and the resident was observed with numerous red, itchy sores on the chest, back, and arms, actively scratching. However, there were no physician orders for contact precautions in the electronic health record, and the resident’s room did not have contact precautions signage or PPE available at the door on the days of surveyor observation. Staff interviews further demonstrated a lack of implementation of required isolation precautions and surveillance. A CNA reported applying scabies cream to the resident while only wearing gloves and stated they usually did not wear PPE when entering rooms of residents treated for scabies and were unsure who had scabies. An LPN stated that no one had informed staff that the resident actually had scabies, acknowledged not using PPE when entering the room, and confirmed that the resident’s roommate had not been moved and that no contact isolation sign was posted. The DON stated that no skin scrapings had been done on any residents with scabies, that surveillance records were not being kept despite residents being treated as scabies cases, and confirmed that no isolation precautions were implemented on residents’ doors. The administrator stated they were unaware that any residents were being treated for scabies until informed by surveyors.
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