Davita Tucson West Dialysis

“IC-CDC MMWR 2001 CFR(s): 494.30(a) The facility must demonstrate that it follows standard infection control precautions by implementing- (1)(i) The recommendations (with the exception of screening for hepatitis C), found in “Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients,” developed by the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, volume 50, number RR05, April 27, 2001, pages 18 to 28. The Director of the Federal Register approves this incorporation by reference in accordance with 5 U.S.C. 552(a) and 1 CFR Part 51. This publication is available for inspection at the CMS Information Resource Center, 7500 Security Boulevard, Central Building, Baltimore, MD or at the National Archives and Records Administration (NARA). Copies may be obtained at the CMS Information Resource Center. For information on the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov/federal_register/code_of_regulations/ibr_locations.html. The recommendation found under section header “HBV-Infected Patients”, found on pages 27 and 28 of RR05 (“Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients”), concerning isolation rooms, must be complied with by February 9, 2009. This Standard is not met as evidenced by: 51929 Based on review of facility policies/procedures, observations during tour, and staff interviews, it was determined that the facility failed to require (3) of (3) patients (Patients #2, 3,7) wash their vascular access and perform hand hygiene prior to and after treatment. This deficient practice posed the potential for cross contamination between patients, staff and visitors as well as high risk for access site infection. Findings include: The facility policy “INFECTION CONTROL FOR DIALYSIS FACILITIES” requires, “...Patients and caregivers will be encouraged to a. Wash their hands and access extremity upon entering the treatment area prior to the initiation of dialysis. b. Perform hand hygiene after treatment before leaving treatment area....” The facility policy “ARTERIOVENOUS FISTULA (AVF) AND ARTERIOVENOUS GRAFT (AVG) VASCULAR ACCESS CARE” requires: “...Patients are encouraged to wash access extremity with soap and water upon arrival for dialysis, if able. If patient is unable to wash access site, patient care teammate will clean access extremity with skin cleansing agent and pat dry....” During a tour of the facility conducted 12/10/2024, the surveyor observed medical equipment including IV poles, wheelchairs and a Liko Lift stored in front of the patient hand washing sink. Patient #2, 3 and 7 were unable to access the patient hand washing sink due to the medical equipment stored in the area. Staff observation on 12/10/2024 did not reveal evidence of staff cleansing patient’s vascular access with a cleansing agent prior to initiation of cannulation procedures. Employee #6 confirmed on 12/10/2024 that staff are not using a cleansing agent prior to accessing sites for cannulation. Employee #1 confirmed on 12/11/2024 the handwashing sink for patient use was obstructed and prevented patients from washing hands and access upon arrival. Employee #32 confirmed on 12/11/2024 that if patients do not wash their vascular access upon entering the treatment floor, staff are required to utilize a product called PAWS to pre-clean the access prior to cannulation process.”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 51929 Based on document review, observation, and interview, it was determined that the facility administrator failed to ensure staff failed to disinfect stethoscope after patient use which poses a potential risk of increased infection for patients through contact transmission and cross contamination of pathogenic organisms that may be harbored on the dirty stethoscope. Findings include: The facility policy titled, “INFECTION CONTROL FOR DIALYSIS FACILITIES” revealed “...Non-disposable items are to be disinfected after each patient use, prior to removal from treatment area/station and if contaminated between uses. If item cannot be cleaned and disinfected it will be dedicated for use on a single patient. a. Stethoscopes will be disinfected with alcohol prep pad and/or 1:100 (one to one hundred) bleach solution and if they are visibly contaminated with blood or body fluids should be disinfected with a 1:10 (one to ten) bleach solution. Observation on 12/10/2024 revealed Employee #6 grabbed the stethoscope from the wall, wiped the diaphragm only with an alcohol swab, took the Stethoscope to use on the patient in station #18. Employee #6 then hung the stethoscope on the wall at the nurse’s station without disinfecting after use on the patient. Observation on 12/11/2024 revealed Employee #8 remove the stethoscope from the hook on the wall, wipe the diaphragm with an alcohol swab, used the stethoscope on a patient in station #4 and returned the stethoscope to the hook without disinfecting. Employees #1 confirmed on 12/11/2024, stethoscopes were not being cleaned according to the facility policy.”

“PERSONNEL-TRAINING PROGRAM/PERIODIC AUDITS CFR(s): 494.40(a) 9 Personnel: training program/periodic audits A training program that includes quality testing, the risks and hazards of improperly prepared concentrate, and bacterial issues is mandatory. Operators should be trained in the use of the equipment by the manufacturer or should be trained using materials provided by the manufacturer. The training should be specific to the functions performed (i.e., mixing, disinfection, maintenance, and repairs). Periodic audits of the operators’ compliance with procedures should be performed. The user should establish an ongoing training program designed to maintain the operator’s knowledge and skills. This Standard is not met as evidenced by: 37489 Based on document review and interview, it was determined that the facility failed to ensure (1) of (2) staff correctly performed the total chlorine test and sustained knowledge of training on the testing procedures and the correct procedures to implement in the event of a chlorine breakthrough which has the potential risk of harm to patients if there is a chlorine breakthrough in the dialysis water used to provide treatments. Findings include: The facility policy titled “SERIM HISENSE ULTRA 0.1 (Trademark) TEST FOR TOTAL CHLORINE IN FEED OR RINSE WATER” requires: “...Using the sample cup provided fill the sample cup with 20 ml water to be tested. Discard contents and refill before testing...Rinsing the medicine cup with the 20 ml water sample will remove any residual from previous sample testing...Immerse the...test strip...for 30 seconds...Remove the test strip...Immediately compare reacted test strip to the color chart...Delaying comparison of the reacted test strip...may cause test results to be reported inaccurately...If the Quantitative test, confirms a total chlorine level...greater than 0.1 ppm (mg/L...Refer to the Total Chlorine Monitoring Decision Tree for specific operator actions required when primary carbon filter total chlorine breakthrough occurs...Immediately Perform Total Chlorine Test on Secondary Carbon Tank...result less than or equal to 0.1 ppm...yes...Every 30 minutes, repeat Total Chlorine Test on Secondary Carbon Tank....” Observation on 1210/2024 revealed Employee #13 perform a total chlorine test using Serim Hisense test strips. Employee #13 did not rinse the sample cup, filled with 30 ml water test sample, processed the test strip for 30 seconds, then waited 30 seconds to read the test strip results. Additionally, Employee #13 verbalized that if there was a chlorine breakthrough on the first test that a test would be performed on the secondary tank and if that was within normal limits the retesting schedule would be every 15 minutes. Employee #13’s personnel file revealed a signed competency check list that training was provided in chlorine testing completed 10/25/2024. Employee #22 confirmed on 12/10/2024 that Employee #13 did not perform the chlorine test correctly as required by policy for the type of test strips used, nor did the staff member correctly verbalize the frequency of retesting in the event of relying on the secondary carbon tank with primary tank breakthrough. Additionally, Employee #22 confirmed that competency for chlorine testing was not sustained.”

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 51929 Based on documentation, observation and interview, it was determined that the facility failed to ensure staff provide a safe treatment environment for staff, patients, and the public during times of potential chemical spills or splatter which poses a high potential for a chemical spill/injury. Findings include: 12/10/2024, the surveyor observed two carts of plastic mixing containers on the treatment floor approximately one quart in size. They were filled with clear liquid without a lid. The contents smell strongly of a type of chemical. The plastic containers listed a Hazardous Material Information Sheet (HIMS) label. The HIMS label revealed that the contents cause possible irritation or minor injury and require safety glasses and gloves when handling. The “Safety Data Sheet (SDS)” for Citric Acid revealed: “...7.2 CONDITIONS OF SAFE STORAGE....Store in tightly closed container/bag....” Employee’s #1, and 22 confirmed on 12/11/2024 that the Citric Acid is used to clean the dialysis machines after the last patient treatments for the day and should not be on the treatment floor in open containers as accidental spill or exposure may occur”