Improper Incontinent and Perineal Care for Male Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate incontinent care and perineal hygiene to prevent UTIs and restore continence for a male resident who was incontinent of bladder. The resident was an adult male with multiple medical diagnoses including reduced mobility, mild protein-calorie malnutrition, sequelae of cerebral infarction with left-sided hemiplegia/hemiparesis, secondary hypertension, hyperlipidemia, lack of coordination, cognitive communication deficit, dependence on supplemental oxygen, need for assistance with personal care, generalized muscle weakness, and gait and mobility abnormalities. His admission MDS showed a BIMS score of 15/15, indicating intact cognition, and his care plan documented an ADL self-care deficit with total dependence on staff for personal hygiene and toileting, including interventions for timely brief changes to prevent skin breakdown. During an observed episode of incontinent care, a CNA washed her hands and donned clean gloves, then unfastened the resident’s soiled brief and used wet wipes to clean the groin but did not clean the penis or scrotum. After repositioning the resident on his side, the CNA cleaned between the buttocks several times but did not clean the surrounding buttock area and did not change gloves at any point during the care. Without changing gloves, she opened a jar of zinc oxide ointment, applied it to the buttocks and groin, then placed a clean brief on the resident before removing the soiled gloves and washing her hands. In a subsequent interview, the CNA stated she believed she had done a good job, acknowledged she forgot to change gloves because she was confused when the resident’s wife handed her the ointment, and confirmed she had been in-serviced on incontinent care and knew that not changing gloves and not properly cleaning the buttocks and scrotum could cause more skin breakdown, odors, and UTIs. The facility’s written perineal care policy required thorough cleaning of the penis, scrotum, perineal area, and rectal area, with appropriate rinsing and drying, which was not followed in this instance.
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