Failure to Follow Enhanced Barrier Precautions During Catheter and Wound-Related Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure staff followed its infection prevention and control program, specifically enhanced barrier precautions, for a resident with multiple wounds and a urinary catheter. The resident had osteomyelitis of the sacral vertebra, peripheral vascular disease, neuromuscular bladder dysfunction, and was dependent on staff for toileting, transfers, and bed mobility. The resident’s MDS showed intact cognition, urinary catheter use, and receipt of ointments/medications to areas other than the feet. The care plan identified the resident as at risk for infection related to wounds and included interventions such as enhanced barrier precautions. Physician orders directed daily wound care to the chest, bilateral calves, and right heel. A CDC enhanced barrier precautions sign was posted outside the room, stating that providers and staff must wear gloves and a gown for high-contact resident care activities, including device care such as urinary catheter care and wound care requiring dressings. During observation, a CNA entered the resident’s room to provide urinary catheter care without donning a gown, despite the enhanced barrier precautions signage and the resident’s status. The CNA performed hand hygiene and donned gloves but placed a basin of warm soapy water directly on the bedside table without a barrier, completed catheter care, then threw the used washcloth onto a cloth towel laid on the floor. After emptying the basin and changing gloves, the CNA emptied the urinary drainage bag into a urinal and reinserted the drainage tubing tip into the storage sleeve without cleaning it with alcohol. The CNA then picked up the towel and dirty washcloths from the floor and placed them in a plastic bag, and also placed a stained bath blanket from the bed into the same bag, allowing the linen to come into contact with the CNA’s uniform. The CNA stated they did not believe the enhanced barrier sign applied to this resident and acknowledged not using a gown. An RN confirmed the resident was on enhanced barrier precautions for wounds and a urinary catheter and that staff should be using gowns for catheter care; washable gowns were observed hanging on the back of the resident’s door. Facility policy required staff to wear an impervious gown for high-contact care, including hygiene, linen changes, toileting assistance, and device care such as urinary catheters and wound care.
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