Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to follow its infection prevention and control program, including Enhanced Barrier Precautions (EBP) and wound care hand hygiene requirements, during wound care for Resident #91. Resident #91 was admitted with multiple conditions including diabetes mellitus, peripheral vascular disease, infection related to an indwelling urethral catheter, and an acquired absence of left toes following surgical amputation. The resident had an indwelling Foley catheter, a surgical wound to the left foot, an unstageable pressure ulcer to the left heel, and deep tissue injuries to both buttocks, and was care planned for EBP and wound treatments as ordered. Physician orders directed specific wound care to the left heel and left lateral surgical site, including cleansing with soap and water or Vashe and application of various dressings and wraps. During an observed wound care procedure, an LPN performed dressing changes on the resident’s left foot pressure ulcer and surgical site with assistance from a CNA who helped position the leg and foot. The LPN did not wash her hands or use hand sanitizer after removing the soiled dressings, before cleansing the wounds, or before applying new dressings, contrary to the facility’s wound care policy that required glove removal and hand hygiene between removal of old dressings, wound cleansing, and application of new dressings. The LPN later confirmed she did not perform hand hygiene at these points. Additionally, neither the LPN nor the CNA donned an isolation gown during the wound care, despite the resident being on EBP and having an indwelling catheter, as indicated by a sign posted outside the resident’s room. Further observations on the Memory Care Unit, where the resident resided, showed that EBP supplies were intended to be kept in a bag on the back of resident doors, but only one shared room had the required supplies available. The CNA confirmed she did not wear an isolation gown and was unsure if she was supposed to, and also confirmed there were no isolation gowns available in or near the resident’s room. The LPN reiterated to the CNA that EBP was only needed if there was contact with urine and not for general patient care, which conflicted with the facility’s EBP policy stating that gowns and gloves are required for high-contact care activities such as wound care for residents with wounds and indwelling medical devices. The DON stated that staff were required to wear gowns and gloves for hands-on care of residents on EBP and that PPE was available through central supply, and also confirmed that hand hygiene should occur after removing soiled dressings and before applying clean dressings.
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