Failure to Implement Proper Peri Care and EBP to Prevent UTIs
Penalty
Summary
The deficiency involves the facility’s failure to ensure proper peri care techniques, including use of Enhanced Barrier Precautions (EBP), appropriate glove changes, and hand hygiene, to prevent or mitigate the risk of urinary tract infections for two residents. One resident had diagnoses of cystitis without hematuria, neuromuscular dysfunction of the bladder, a personal history of UTIs, diabetes, and an indwelling Foley catheter, and was care planned for EBP and frequent perineal care with monitoring for UTI signs and symptoms. Nursing orders directed staff to follow EBP during catheter maintenance and to keep the perineal area clean and dry, while the resident’s assistant care sheet identified contact precautions for diarrhea and an indwelling Foley catheter. Despite these orders and care plans, staff did not consistently follow required infection prevention practices during high-contact peri care. During observations, a nursing assistant in training provided peri care to the catheterized resident after an episode of loose stool while wearing a gown but failed to perform hand hygiene between glove changes. The assistant removed soiled items, handled trash, and manipulated items in the room with contaminated gloves before sanitizing hands only after leaving the immediate care area. Later, another nursing assistant entered the same resident’s room without donning EBP despite signage on the door, did not wash hands before putting on gloves, and did not wear a gown. This assistant removed a soiled brief with dark brown liquid stool pooled over the resident’s vaginal area and into abdominal folds, allowed stool to contact her gloved hand, then touched the resident’s thigh leaving visible stool without changing gloves. She rolled the resident over soiled pads, wiped stool around the vaginal folds and catheter area without changing gloves or performing hand hygiene, wiped the catheter toward the vaginal area, and continued wiping stool toward the vaginal area. She then applied powder under the abdominal fold, handled room items, call lights, cupboards, garbage, and dirty linens while still wearing the same contaminated gloves, and exited the room without appropriate glove changes or hand hygiene. For the same catheterized resident, a registered nurse entered the room on observation without donning gown and gloves despite the EBP sign on the door. The RN used a stethoscope to assess bowel sounds and applied and reapplied a blood pressure cuff on both arms without wearing EBP. In a separate case, another resident with hemiplegia and documented bowel and bladder incontinence, care planned for peri care with staff assistance, received peri care from a nursing assistant who wiped stool from the resident’s bottom and removed a soiled brief, then obtained a clean brief from a drawer without removing gloves or performing hand hygiene. The assistant touched the resident’s shirt with dirty gloves, applied Tena cream, and wiped the inner thighs and vaginal area in multiple directions, then placed a new brief. After removing gloves, the assistant did not perform hand hygiene before handling clean shirts in the closet, dressing the resident, and transferring the resident to a wheelchair, only sanitizing hands when leaving the room. Interviews with an RN, an LPN care coordinator, and the DON/IP revealed that audits or supervision of nursing assistants’ peri care practices to reduce UTI risk were not being conducted, and the DON/IP stated she had not identified UTI trends and did not obtain UA/UC reports from hospitals, despite facility policies outlining catheter care steps, front-to-back wiping, glove changes, hand hygiene, and use of EBP for residents with medical devices.
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