Failure to Follow Infection Control Practices During Medication Administration and Enhanced Barrier Precautions
Penalty
Summary
The deficiency involves failures in infection prevention and control practices during medication administration and resident care. For one resident, a Certified Medication Technician (CMT) prepared multiple oral medications by placing each tablet directly into his or her bare hand before transferring them into a medication cup. The medications included aspirin 81 mg, metoprolol tartrate 12.5 mg, and potassium chloride extended release 20 meq, which were scheduled on the resident’s Medication Administration Record. This practice occurred despite the facility’s Medication Administration Policy, which specifies that medications are to be administered in a manner that prevents contamination or infection and that staff should remove medications from their source without touching them with bare hands. The CMT later acknowledged awareness that medications should not be handled with bare hands and stated he or she did not realize bare hands had been used during preparation. A second deficiency concerns the facility’s failure to implement Enhanced Barrier Precautions (EBP) and appropriate glove use during high-contact care for a resident with significant infection risks. This resident had diagnoses including dysphagia, stroke, unspecified dementia, was always incontinent of bowel and bladder, had a feeding tube, was at risk for pressure ulcers, and had one or more unhealed pressure ulcers with a documented MRSA-positive wound culture from the left heel. The resident’s care plan and physician orders required EBP, including the use of gown and gloves during high-contact resident care activities such as dressing, bathing, transfers, linen changes, incontinence care, wound care, and device care for the feeding tube. A sign on the resident’s door clearly indicated EBP requirements, and gowns and other EBP supplies were available outside the room. During observed incontinence care for this resident, a CNA and an LPN entered the room and provided high-contact care while wearing gloves only and no gowns, despite the posted EBP sign and the resident’s need for EBP due to a feeding tube and chronic wounds with MRSA. The resident was incontinent of bowel and bladder, and the CNA performed perineal and incontinence care while the LPN assisted with positioning and turning. The CNA removed soiled gloves, performed hand hygiene, donned new gloves, and continued care until all feces were removed. Without changing gloves again, the CNA then picked up a tube of barrier cream from the bedside table, touched the resident’s hip, and applied the cream to the resident’s buttocks. Interviews with the CNA, LPN, Infection Preventionist, and DON confirmed that staff were aware EBP was required for this resident, that gowns and gloves should be used for high-contact care, and that gloves should be changed when moving from dirty to clean tasks and before handling barrier cream, but these practices were not followed during the observed care.
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