Failure to Follow Infection Control Practices During Trach and Incontinence Care
Penalty
Summary
The deficiency involves failure to maintain infection prevention and control practices during tracheostomy care for one resident. The resident was admitted with diagnoses including acute respiratory failure, epilepsy, kidney failure requiring hemodialysis, tracheostomy, and gastrostomy, and had a physician’s order for tracheostomy care every shift. During an observation of trach care, surveyors noted a used trach collar with attached tubing lying directly on a tabletop in the resident’s room without any barrier underneath it, and a white washcloth placed on top of the used trach collar. In an interview, the RN confirmed the used trach collar and tubing were on the table without a barrier and stated the nurse must have removed the trach collar and tubing prior to the resident going to dialysis. Facility policy on Infection Prevention and Infection Control required standard precautions to be universally applied in the care and treatment of all residents. A second deficiency involved failure to follow hand hygiene and glove-use standards during incontinence care for another resident. During observed perineal care, a CNA cleansed under the resident’s panniculus, where the skin was reddened with chunks of old skin and powder, while wearing gloves, then applied barrier cream and proceeded to clean the perineal area without performing hand hygiene or changing gloves. The CNA then assisted with removing the resident from a bedpan, cleaned the bedpan, washed her hands, and changed gloves, and completed the remainder of incontinence care, including cleaning the gluteal area, without further hand hygiene until all care was completed. In an interview, the CNA confirmed she performed hand hygiene only once during the care and could not recall when she was last educated on hand hygiene. Facility policies on Perineal Care and on Standard Precautions and Transmission-Based Precautions required hand hygiene before applying gloves, after completing skin care, and after glove removal, and required gloves to be changed between clean and dirty tasks and after contact with materials that may contain high concentrations of microorganisms.
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