Failure to Provide Complete Perineal Care and Proper Hand Hygiene During Incontinence and Catheter Care
Penalty
Summary
The deficiency involves the facility’s failure to provide complete incontinence and catheter-related care, including appropriate perineal cleansing and hand hygiene, for multiple residents with bowel and bladder incontinence and/or indwelling catheters. One resident with a history of UTIs, an indwelling Foley catheter placed for pressure ulcers, cognitive impairment, and total dependence for toileting was observed after a bowel incontinence episode. Two CNAs assisted the resident to her side and used wet washcloths to wipe only the anal area, then repositioned and covered her without cleansing the entire buttocks or performing full incontinent care as outlined in her care plan and facility policy. Another resident, cognitively intact but frequently incontinent of urine and always incontinent of bowel, and dependent on staff for toileting, was assisted from a wheelchair to a bedside commode. Staff exposed a heavily urine-soaked brief, seated the resident on the commode, and later applied a clean brief. During cleansing, a CNA used a wet washcloth to clean only the buttocks before the brief and pants were pulled up. The staff did not cleanse the entire buttocks, perineal area, groin, inner thighs, or labia, despite the resident’s care plan directing assistance with toileting every two hours and as needed. A third resident with multiple chronic conditions, moderate cognitive impairment, frequent bowel and bladder incontinence, and dependence for ADLs was provided incontinent care while in a wheelchair using a sit-to-stand device. CNAs donned gloves without performing hand hygiene, removed a wet brief, and one CNA changed gloves without hand hygiene, then used only wet washcloths from the sink without soap or peri-cleaner to briefly wipe the front genital area and buttocks; the anal area was not cleaned. The same soiled gloves were then used to handle the resident’s clothing, equipment, and positioning. A fourth resident with severe cognitive impairment, total dependence for ADLs, and constant bowel and bladder incontinence was observed with a saturated, strong-smelling urine brief. A CNA, wearing the same soiled gloves used to remove the saturated brief, used wet cloths from a basin to wipe the vagina, buttocks, and anal area, then a dry cloth, and subsequently touched the resident’s pillows, sheets, and blanket without any glove change or hand hygiene. These practices were inconsistent with the facility’s written policies for incontinence care, glove use, and hand hygiene, which require thorough perineal cleansing, use of soap or peri-cleaner, changing gloves between contaminated and clean tasks, and performing hand hygiene after glove removal.
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