Failure to Follow Enhanced Barrier Precautions for Residents With Wounds and Indwelling Catheters
Penalty
Summary
The deficiency involves the facility’s failure to implement and maintain its Enhanced Barrier Precautions (EBP) policy for residents requiring infection prevention measures. The facility’s written policy, dated January 2025, required the use of gown and gloves during high-contact resident care activities for residents with applicable conditions or devices, such as wounds and indwelling urinary catheters, even if multidrug-resistant organism (MDRO) status was unknown. High-contact activities were defined to include dressing, bathing, transferring, providing hygiene, changing linens or briefs, assisting with toileting, urinary catheter care, and wound care. Resident #5 had a physician’s order for EBP related to a stage 3 pressure ulcer of the left buttock, and Resident #R1 had multiple non-pressure chronic ulcers of the left lower extremity, pressure ulcers of the left ankle and heel, and an indwelling urinary catheter documented in the care plan. On multiple observations, staff did not follow the EBP requirements for gown use during direct care of these residents. A treatment nurse provided wound care to Resident #5 wearing gloves but no gown, and there was no EBP signage on the resident’s door at that time. Later, a CNA was observed emptying Resident #R1’s indwelling catheter wearing gloves but no gown, despite EBP signage on the door, and confirmed she had not donned a gown. The same CNA was subsequently observed changing Resident #5’s brief while wearing gloves but no gown and acknowledged she had forgotten to wear a gown, even though an EBP sign was posted above the resident’s bed. The treatment nurse later confirmed she did not wear a gown for Resident #5’s wound care and stated she only used gowns for “big wounds or infections.” The DON stated that residents with infections, PEG tubes, wounds, colostomies, ostomies, urinary catheters, tube feedings, and pressure ulcers should be on EBP and confirmed staff should wear gown and gloves when emptying urinary catheters or providing wound care.
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