Inadequate Infection Control During Wound Care and Unclear PPE Use Under Enhanced Barrier Precautions
Penalty
Summary
The deficiency involves a failure to implement infection prevention and control guidelines during a wound dressing change and a lack of staff understanding of required PPE for a resident on Enhanced Barrier Precautions. During an observed wound treatment for Resident C, an RN removed the existing foam dressing from the resident’s left foot, left the room to clarify treatment orders, and later returned with an NP who assessed the wound and provided new verbal orders to cleanse with betadine, apply a 4x4 gauze, and wrap with Kerlix. After cleansing the wound with a betadine-soaked pad and covering it with clean gauze, the RN began to unroll the Kerlix but realized there was no tape available. The RN then set the Kerlix roll down and rummaged through the resident’s side dresser drawers with gloved hands in search of tape, then returned to the Kerlix roll and resumed dressing the wound without performing hand hygiene or changing gloves after touching the dresser drawers. The deficiency also includes the RN’s uncertainty regarding appropriate PPE use for a resident requiring Enhanced Barrier Precautions. After completing the Kerlix wrap and doffing PPE to search for tape, the RN later appeared at the resident’s doorway and questioned whether applying tape was “gown worthy,” indicating he was unsure if a gown was required to re-enter and apply tape to the dressing. Resident C’s record showed diagnoses including a non-pressure ulcer of the left foot, heart failure, anemia, and restless leg syndrome, with a care plan addressing alteration in skin integrity of the left foot and directing staff to complete treatments as ordered and observe for signs and symptoms of infection. During an interview, the DON acknowledged understanding the concern that the nurse should have changed gloves after searching for tape in the resident’s dresser drawers.
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