HOUSTON, MS - State health inspectors documented infection control violations at Trend Health and Rehab of Houston during an April 2025 survey, finding that staff failed to post required isolation precautions for a resident with an active MRSA infection and did not consistently follow protective equipment protocols when caring for residents with medical devices.
Missing MRSA Isolation Signage Created Risk of Infection Spread
During the inspection on March 30, 2025, surveyors discovered that Resident #1, who had active Methicillin Resistant Staphylococcus Aureus (MRSA) infections in wounds on both lower legs, had no signage posted outside his room indicating he was on contact isolation precautions. While an isolation organizer hung on the door, there were no instructions specifying what type of personal protective equipment (PPE) staff and visitors needed to wear when entering the room.
The facility's Infection Preventionist confirmed during an interview that the resident had MRSA in his leg wounds and was receiving antibiotic treatment. She acknowledged that "the proper use of PPE helped prevent the spread of an infection" and admitted the resident did not have the required signage on his door. The Administrator further confirmed that when a resident is placed in contact isolation, the facility's policy requires posting the type of precaution and PPE requirements in a visible area outside the room.
MRSA is a dangerous antibiotic-resistant bacteria that spreads easily through direct contact with infected wounds or contaminated surfaces. In healthcare settings, proper isolation signage serves as the first line of defense, alerting all staff members, visitors, and other personnel to don appropriate protective equipment before entering a room. Without clear signage, staff members unfamiliar with a resident's status might enter without protection, potentially carrying the bacteria to other vulnerable residents on their clothing or hands.
The resident's medical records showed he had been admitted with bacterial infections and non-pressure chronic ulcers of both lower legs, along with venous insufficiency. His quarterly assessment indicated moderate cognitive impairment with a Brief Interview for Mental Status score of 10, meaning he may not have been able to reliably inform visitors or staff about his infection status himself.
Staff Member Failed to Wear Required Protective Equipment During Tube Feeding
Inspectors observed a more direct breach of infection control protocols on April 1, 2025, when Licensed Practical Nurse #1 administered medications through Resident #9's PEG tube without wearing the required protective gown. The facility had implemented Enhanced Barrier Precautions (EBP) for this resident specifically because of his feeding tube, yet the nurse failed to follow these essential protocols.
When questioned immediately after the observation, the nurse admitted she knew she should have worn protective equipment. She stated that "EBP is supposed to be utilized when providing care to the resident since he has a PEG tube" and revealed, "we even discussed wearing the gown when I gave him his medications this morning, but I got nervous and forgot to do it."
PEG tubes, or percutaneous endoscopic gastrostomy tubes, are medical devices inserted directly through the abdominal wall into the stomach. These devices create a direct pathway into the body that bypasses normal immune defenses, making residents particularly vulnerable to infections. Enhanced Barrier Precautions require healthcare workers to wear gowns and gloves during high-contact care activities with residents who have such devices, as these activities present increased risk for transmitting multidrug-resistant organisms.
The resident's medical records indicated he had been admitted with hemiplegia and hemiparesis following a cerebral infarction (stroke), conditions that left him with partial paralysis and dependent on the feeding tube for nutrition and medications. His physician had ordered Enhanced Barrier Precautions to be followed during every shift specifically because of the PEG tube.
Facility Policies Not Consistently Implemented
The facility's own infection control policies clearly outlined requirements that were not being followed. The Enhanced Barrier Precautions policy, dated October 2023, specifically stated that the facility would "implement enhanced barrier precautions for the prevention of transmission of multidrug-resistant organisms" and required "clear signage will be posted on the door or wall outside of the resident room indicating the type of precautions, required personal protective equipment (PPE), and the high-contact resident care activities that require the use of gown and gloves."
The Interim Director of Nursing confirmed that proper PPE should have been worn when administering medications through the PEG tube, explaining that "EBP is implemented to protect the residents and the staff from spreading germs." The Infection Control Nurse echoed this, stating that for any residents under Enhanced Barrier Precautions, "the facility's requirements and expectations are that the staff wear the proper PPE to reduce the possible spread of infections."
Medical Significance of Infection Control Breaches
These violations represent fundamental breakdowns in infection prevention that could have serious consequences in a nursing home setting. Elderly residents often have weakened immune systems, multiple chronic conditions, and are taking medications that further suppress their ability to fight infections. When infection control protocols fail, dangerous pathogens can spread rapidly through a facility.
MRSA infections in particular pose significant risks in long-term care settings. This antibiotic-resistant bacteria can cause severe skin and soft tissue infections, bloodstream infections, and pneumonia. In residents with existing wounds, as was the case with Resident #1, MRSA can prevent healing and lead to deeper tissue damage. The bacteria can survive on surfaces for weeks, making environmental contamination a persistent threat when proper precautions aren't followed.
For residents with medical devices like PEG tubes, the stakes are equally high. Infections at tube sites can progress to peritonitis, an infection of the abdominal cavity that requires aggressive treatment and can be life-threatening. Additionally, bacteria introduced during tube feeding can cause aspiration pneumonia, a serious lung infection that represents one of the leading causes of death in nursing home residents.
Pattern of Non-Compliance
The inspection report noted that violation F880, relating to infection prevention and control programs, had also been cited during the facility's previous annual recertification survey. This pattern suggests ongoing challenges with implementing and maintaining consistent infection control practices, despite having written policies in place.
The facility's infection prevention program policy stated its purpose was to "provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections." However, the observed failures in both signage and PPE use demonstrate gaps between written policy and actual practice.
Industry Standards and Expected Practices
According to Centers for Medicare & Medicaid Services guidelines and industry best practices, nursing homes must maintain robust infection prevention programs that include clear communication systems, consistent use of barrier precautions, and ongoing staff training. Proper signage serves multiple critical functions: it reminds staff of necessary precautions, informs visitors who may not be familiar with a resident's status, and helps maintain consistency across all shifts.
For residents requiring contact isolation or enhanced barrier precautions, facilities should implement multiple layers of protection. This includes placing clear, standardized signage at eye level outside resident rooms, maintaining adequate supplies of PPE immediately outside isolated rooms, conducting regular audits to ensure compliance, and providing refresher training when lapses are identified.
The admission of the nurse who forgot to wear required PPE despite discussing it earlier that morning highlights the importance of systematic approaches to infection control rather than relying on individual memory. Facilities should implement checkpoint systems, buddy monitoring, and visual reminders to support consistent compliance with protective equipment requirements.
Additional Issues Identified
Beyond the major infection control violations, the inspection revealed systemic issues with the facility's implementation of its own policies, inadequate staff oversight to ensure compliance with established protocols, and failure to maintain consistent infection prevention practices despite previous citations for similar violations.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Floy Dyer Nh from 2025-04-02 including all violations, facility responses, and corrective action plans.
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