062557 Kidney Center of Longmont (Ara)

“IC-CATHETERS:GENERAL CFR(s): 494.30(c)(2) (2) The “Guidelines for the Prevention of Intravascular Catheter-Related Infections” entitled “Recommendations for Placement of Intravascular Catheters in Adults and Children” parts I - IV; and “Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients,” Morbidity and Mortality Weekly Report, volume 51 number RR-10, pages 16 through 18, August 9, 2002. 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 as 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 This Standard is not met as evidenced by: 45020 Based on observations, interviews, and document review, the facility failed to ensure patient care staff allowed dry time after the hub of the central venous catheter (CVC, a device inserted through the skin for direct access to a large vein in the patient for dialysis treatment) was cleaned in two of four observations of CVC end of treatment procedures. Findings include: Facility policy: The CVC Initiation and Discontinuation of Treatment policy read, wash hands, and don new clean gloves. Place a clean field under the catheter limbs/caps. Disinfect according to manufacturer’s instructions. Allow disinfectant to air dry. Prior to cap removal, disinfect the arterial cap and limb. Using the same antiseptic pad, apply antiseptic with friction to the catheter. Hold the limb until the catheter is dry. Repeat for the venous limb, using a new disinfectant pad. Ensuring the limb clamp is closed, remove the arterial cap and disinfect the hub with a new disinfectant pad. Scrub the sides (threads) and end of the hub thoroughly with friction. Antiseptics should be allowed to dry for maximum effect. This step decreases the risk of microorganisms entering the catheter lumen. 1. The facility failed to ensure patient care staff allowed dry time after the hub of the CVC catheter was cleaned. A. Observations i. On 8/6/24 at 10:15 a.m., an observation was conducted of a CVC end of treatment procedure at station #13. After the dialysis lines were removed from the patient the CVC was prepared for the patient to leave the facility. Patient care technician (PCT) #1 scrubbed the red hub for 30 seconds, no dry time was observed, then a syringe that contained heparin was attached to the red hub and administered. PCT #1 scrubbed the blue hub for 30 seconds, no dry time was observed, then a syringe that contained heparin was attached to the blue hub and administered. The heparin syringe was then removed and the hub was again scrubbed with an alcohol pad for 30 seconds and no dry time was observed. PCT #1 removed the syringe from the red hub, scrubbed the hub for 30 seconds, and immediately applied a red cap. PCT #1 then removed the syringe from the blue hub, scrubbed the hub for 30 seconds, and immediately applied a blue cap. Both hubs were visibly wet when the new caps were applied. ii. On 8/6/24 at 10:46 a.m., an observation was conducted of a CVC end of treatment procedure at station #14. After the dialysis lines were removed from the patient the CVC was prepared for the patient to leave the facility. PCT #1 scrubbed the blue hub for 30 seconds, no dry time was observed, then a syringe that contained heparin was attached to the blue hub and administered. PCT #1 scrubbed the red hub for 30 seconds, no dry time was observed, then a syringe that contained heparin was attached to the red hub and administered. The heparin syringe was then removed and the hub was again scrubbed with an alcohol pad for 30 seconds and no dry time was observed. PCT #1 removed the syringe from the red hub and scrubbed the hub for 30 seconds, a seven second dry time was observed, and a new red cap was then applied to the hub while the hub remained visibly wet. PCT #1 then removed the syringe from the blue hub, scrubbed the hub for 30 seconds, a four second dry time was observed, and a new blue cap was applied while the hub remained visibly wet. PCT #1 stated the dry time was 15 seconds. This was in contrast to the CVC Initiation and Discontinuation of Treatment policy which instructed to scrub the sides (threads) and end of the hub thoroughly with friction and dry for maximum effect. B. Interviews i. On 8/7/24 at 12:10 p.m., an interview was conducted with PCT #2. PCT #2 stated a CVC was a line used to connect patients to a machine for dialysis treatments. PCT #2 stated proper technique was important, especially with catheters because catheters were prone to infection. PCT stated CVC hubs were to be scrubbed with an alcohol pad for 30 seconds and allowed to air dry for 15 seconds before anything was attached to the hub. PCT #2 stated CVC care was important because there was a risk of infection which could cause death. ii. On 8/7/24 at 12:43 p.m., an interview was conducted with PCT #3. PCT #3 stated CVC care was important because the CVC was near the patient’s heart and was prone to infection. PCT #3 stated the hub was to be scrubbed with an alcohol pad for 30 seconds and the dry time after alcohol scrub to the CVC hub was 15 seconds. PCT #3 stated dry time was necessary because it ensured the alcohol was effective for disinfection. PCT #3 stated CVC care was important because there was a risk of infection which could cause sepsis or death. iii. On 8/7/24 at 1:01 p.m., an interview was conducted with registered nurse (RN) #4. RN #4 stated CVC hubs were to be scrubbed with alcohol for 30 seconds and allowed to air dry for 15 seconds because alcohol needed dry time to disinfect the area. RN #4 stated the risk of an infection to a CVC site included sepsis and possible death.”