Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During High-Contact Care
Penalty
Summary
The deficiency involves the facility’s failure to follow its infection prevention and control program, specifically enhanced barrier precautions (EBP) and hand hygiene, during high-contact care for two residents. For one resident with multiple chronic conditions, including stage four chronic kidney disease, osteoporosis, GERD, dysphagia, cognitive communication deficit, and muscle wasting, the quarterly MDS showed cognitive impairment and a need for maximal to dependent assistance with mobility, transfers, and ADLs. Physician orders required EBP for high-contact care, including dressing changes, and nightly wound care to a right foot digit. During observed wound care, an LPN began care by removing the resident’s sock without wearing a gown, left the room, then returned with a gown and gloves. The LPN removed the sock, then removed and replaced gloves without performing hand hygiene, and continued wound care. The LPN confirmed she started wound care without a gown and did not perform hand hygiene after glove removal, and was unsure if she should have, despite facility policies requiring hand hygiene during wound care after glove removal and use of gown and gloves for high-contact care under EBP. For a second resident admitted with traumatic subdural hemorrhage, malignant neoplasm of the right kidney, hypovolemic shock, syncope, and a history of falls, the admission MDS showed cognitive intactness and a need for moderate to maximal assistance with ADLs and maximal assistance for transfers. The resident had an indwelling urinary catheter for urinary retention, was bowel incontinent, and was dependent for toileting hygiene and catheter cleansing. Physician orders required EBP for high-contact care and catheter care every shift. During observed catheter care and perineal hygiene, two CNAs did not perform hand hygiene before donning gowns and gloves. One CNA changed gloves during catheter care without performing hand hygiene, and at the end of care the other CNA removed her gown and gloves and left the room without performing hand hygiene. Both CNAs confirmed they did not perform hand hygiene before, during, or after providing catheter care, despite facility policies requiring handwashing before and after perineal hygiene and immediately after glove removal.
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