Failure to Implement Enhanced Barrier Precautions and Proper PPE Use for Device and Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program related to Enhanced Barrier Precautions (EBP) and appropriate use of personal protective equipment (PPE) for multiple residents. One resident with dysphagia had a jejunostomy (J‑tube) with continuous tube feeding and an order for EBP related to the feeding tube. An LPN entered this resident’s room without a gown, wearing only gloves, moved the resident’s personal belongings with the same gloved hands, disconnected the J‑tube feeding, flushed the tube, covered the port, and then left the room still wearing the same gloves. The resident’s physician orders and care plan documented the need for EBP for the J‑tube, and the facility’s EBP policy required gown and gloves for device care, including feeding tubes. The facility also failed to post EBP signage and ensure EBP implementation for residents with chronic wounds. One resident with a sacral wound had no EBP sign on the door, and a wound care RN entered without a gown and performed a pressure dressing change. The physician orders for this resident did not include EBP, and the care plan did not address EBP, despite the facility’s policy stating that EBP should be implemented for residents with chronic wounds and that clear signage indicating required PPE must be posted outside the room. The Infection Control Nurse stated that at that time they did not have wounds requiring EBP, and described EBP as needed for open wounds or pressure sores with significant exudate, while the written policy specified chronic wounds such as pressure ulcers and other long‑lasting wounds. Two additional residents with chronic, full‑thickness wounds and moderate serous exudate also did not have EBP signage or PPE set up outside their rooms. A CNA and another CNA assistant entered one resident’s room to provide incontinence care and transfer without performing hand hygiene before donning gloves, did not wear gowns, and one CNA changed gloves without hand hygiene before continuing care and using a mechanical lift. For another resident with a post‑surgical stump wound, a CNA provided incontinence care wearing gloves but no gown and did not perform hand hygiene before donning or after removing gloves. Both CNAs stated there were no residents on their hallway requiring EBP, while the DON stated that EBP is required for residents with chronic wounds present for more than 30 days and/or with biofilm, and the wound physician’s documentation showed both residents’ wounds had been present for more than 30 days with debridement of slough, biofilm, and devitalized tissue.
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