032558 Bullhead City Dialysis (Fmc)

“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: 37489 Based on document review, observation, and interview, it was determined that the facility failed to ensure nurses cleaned and disinfected their stethoscope between and after use on multiple patients 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 “Cleaning and Disinfecting the Dialysis Station” requires: “...The Centers for Medicare and Medicaid Services (CMS) has regulations that in order to prevent cross contamination, a dialysis station must be cleaned and disinfected between dialysis patients. The chair and dialysis equipment are used by multiple patients during a treatment day and it is critical that these items be thoroughly cleaned and disinfected between used...Also, the nature of dialysis treatments with frequent exposure to blood and body fluids, close proximity of patients and staff, and the immunocompromised status of dialysis patients make dialysis a high-risk area for spreading infectious disease...Dialysis station...General Cleaning...After use, any non-disposable equipment and supplies brought into the dialysis station (ex. Stethoscope) must be disinfected with 1:100 bleach or EPA registered disinfectant before being removed from the dialysis station....” Observation on 01/23/2024 revealed Employee #23 use a stethoscope obtained from the nurses’ station desk to assess the patient at Station #27. Employee #23 completed the nursing assessment, hung the dirty stethoscope around his/her neck, returned to the nurses’ station, placed the stethoscope on the desktop, and charted in the patients record on the desktop computer. Employee #23 completed his/her charting, retrieved the dirty stethoscope from the desk, and walked to Station #22 to assess the patient finishing treatment. Employee #23 hung the stethoscope around his/her neck after use, wheeled the patient out of the clinic, and returned to the nursing station desk to chart without cleaning/disinfecting the stethoscope. Observation on 01/23/2024 revealed Employee #24 use the same stethoscope to assess the patient at Station #2, Station #4, and then again at Station #35 without cleaning/disinfecting the stethoscope between stations and uses. Employee #24 hung the stethoscope around his/her neck after the last use without cleaning/disinfecting the stethoscope. Observation on 01/23/2024 revealed Employee #13 use his/her stethoscope on a patient at Station#9. Employee #13 used liquid hand sanitizer on the stethoscope after use of the patient at the station. The “germstar instant hand sanitizer” label revealed it contained 70% Isopropyl alcohol, water, an emollient, and fragrance. The EPA.gov website revealed: “...Using hand sanitizer kills pathogens on skin...hand sanitizers are regulated by the Food and Drug Administration (FDA)...Surface disinfectant products are subject to more rigorous EPA testing requirements and must clear a higher bar for effectiveness than surface sanitizing products. Many products are registered with EPA as both sanitizers and disinfectants because they’ve been tested using both methods. EPA-registered sanitizers and disinfectants may also contain cleaning agents....” Employee #2 confirmed on 01/23/2024 that nurses did not disinfect their stethoscopes between use on multiple patients at different stations during nursing assessments conducted pre and post dialysis treatment as required by policy with bleach solution or EPA registered disinfectant.”

“PR-PARTICIPATE IN CARE;DISC/REFUSE TX CFR(s): 494.70(a)(5) The patient has the right to- (5) Be informed about and participate, if desired, in all aspects of his or her care, and be informed of the right to refuse treatment, to discontinue treatment, and to refuse to participate in experimental research; This Standard is not met as evidenced by: 37489 Based on document review and interview, it was determined that the facility failed to obtain Patient #7’s consent to be photographed prior to staff taking photos of the patient’s CVC exit site which has the potential risk of the patient’s rights being violated and inability to participate in his/her own care. Findings include: The facility policy titled “ FMCNA Patient Rights Arizona State Specific” requires: “...Help make decisions about your care...Consent to photographs before the patient is photographed, except that a patient may be photographed when admitted to an outpatient treatment center for identification and administrative purposes....” Patient #7’s medical record contained a consent to incenter hemodialysis treatment that was signed on [09/27/2019]. The medical record, nor the consent to treat contained documentation of consent to photograph the patient’s CVC exit site. Employee #1 confirmed on 01/23/2024 that a staff member used Employee #1’s company cell phone to take photographs on [10/19/2022] of Patient #7’s CVC exit site to send to the vascular access center as there was a question of potential catheter cuff migration that needed to be ruled out. Employee #1 confirmed that consent was not obtained from the patient prior to taking the photographs of the patient’s CVC exit site.”