062536 Lamar Dialysis (Fmc)

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 45020 Based on observations, interviews, and document reviews, the facility failed to ensure three of four patients, who were observed holding pressure to their access sites (locations where needles were inserted and then removed for treatment), performed hand hygiene following the removal of soiled gloves and prior to leaving the facility. Findings include: Facility policy: The Hand Hygiene policy read, the purpose of this policy is to prevent transmission of pathogenic microorganisms to patients and staff through cross contamination. All staff, patients, patient care givers, including physicians and non-physician practitioners, social workers, dietitians, and any other indirect patient care staff must follow the same requirements for hand hygiene. Patients should perform hand hygiene if able, prior to and after each dialysis treatment. As needed, direct patient care staff will demonstrate how to operate the sinks, demonstrate hand washing to patients who are able to perform hand washing, and explain the risk of contamination with regard to their vascular access and hands to all patients. To help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed. 1. The facility failed to ensure patients performed hand hygiene following the removal of soiled gloves. A. Observations i. On 6/30/25 at 11:08 a.m., an observation was conducted at station #13. The patient was observed holding pressure to their own access site with a gloved left hand following the removal of the needles used for treatment. At 11:20 a.m., after stabilization of the site, patient care technician (PCT) #1 applied a dressing to the site and removed the glove from the patient’s left hand. PCT #1 assisted the patient to a wheelchair, assisted the patient to the scale and obtained the patient’s weight. Staff did not educate or request the patient to perform hand hygiene before leaving the facility. ii. On 6/30/25 at 12:39 p.m., an observation was conducted at station #9. The patient was observed holding pressure to their own access site with a gloved right hand following the removal of the needles used for treatment. At 12:42 p.m., PCT #2 was observed assisting the patient with their access site that had bled through the gauze. PCT #2 cleaned blood from the patient’s arm, and the patient continued to apply pressure to their access site with their gloved right hand. At 12:52 p.m., after stabilization of the site, PCT #2 reinforced the dressing with gauze and tape. The patient then removed the soiled glove and, without performing hand hygiene, ambulated to the scale. A weight was obtained and the patient exited the facility. Staff did not educate or request the patient to perform hand hygiene following the glove removal. iii. On 6/30/25 at 1:23 p.m., an observation was conducted at station #8. The patient was observed holding pressure to their own access site with a gloved right hand following the removal of the needles used for treatment. At 1:25 p.m., after stabilization of the site, PCT #2 applied a dressing to the site. The patient then removed the soiled glove and without performing hand hygiene, ambulated to the scale and obtained their weight by pressing a button with their right hand. The patient exited the facility. Staff did not educate or request the patient to perform hand hygiene following the glove removal. This was in contrast to the Hand Hygiene policy which stated, to prevent transmission of pathogenic microorganisms to patients and staff through cross contamination, all patients must follow the same requirements for hand hygiene. All patients should have performed hand hygiene after each dialysis treatment. Additionally, direct patient care staff should have explained to all patients the risk of contamination with regard to their vascular access and hands. B. Interviews i. On 7/2/25 at 8:11 a.m., an interview was conducted with PCT #3. PCT #3 stated after patients’ access sites were stabilized, patients were to perform hand hygiene before leaving the facility. PCT #3 stated hand hygiene was important for patients to perform because there was a risk of spreading germs at the scale or the door as they left the facility. PCT #3 stated there was a risk of infection, including hepatitis (inflammation of the liver). ii. On 7/2/25 at 7:57 a.m., an interview was conducted with registered nurse (RN) #4. RN #4 stated after a patient’s access site was stabilized, the expectation was for patients to perform hand hygiene after glove removal and for staff to remind them to do so. RN #4 stated if a patient did not perform hand hygiene after glove removal there was a risk of infection which could result in sepsis (a life-threatening complication of an infection) or hospitalization.”