Nursing Home Staff Fails To Properly Clean Patient With Persistent Incontinence

This case involves an elderly male patient who was admitted to the nursing home after a hospital stay during which he contracted C-Difficile. Upon admission to the nursing home, the patient suffered from fecal incontinence due to the C-Difficile and was not cleaned appropriately by staff. In particular, the patient suffered extensive sores on his buttocks area. The patient suffered deteriorating health and mental status until for almost 2 months before being removed from the nursing home. Upon removal, he required an additional hospital visit for acute care.

Question(s) For Expert Witness

1. Please explain your background in nursing home administration.

2. What protocols or practices should be in place to prevent oversight in nursing care?

Expert Witness Response E-000382

I work as a supervisor in the nursing home setting. I have also worked as a staff development and infection control nurse in the skilled nursing home setting. Due to the potential risk of mortality that coincides with someone having a C-Difficile infection as well as the risk of C-Difficile being transmitted to other patients, there have to be policies and procedures in place for caring for patients with C-Difficile. This would include nursing care protocols. Evidence of training of all nursing home staff (especially nursing staff) regarding how to care for someone with C-Difficile is required. C-Difficile patients must reside in a private room and strict isolation precautions are put in place. Mask, a gown, gloves, and shoe covers must be worn by all staff caring for the patient. Due to the frequency of bowel movements and the potential for skin breakdown, frequent and complete incontinence care must be carried out with barrier creams used to protect the skin from breakdown. These are just a few of the practices that should be in place.