Davita Parker Dialysis Center

“CFC-INFECTION CONTROL CFR(s): 494.30 This Condition is not met as evidenced by: 45020 Based on the manner and degree of the standard level deficiencies referenced to the Condition, it was determined the Condition of Participation §494.30 Infection Control, was out of compliance. V113 - 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. Based on observation and interviews, the facility failed to ensure two of three 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. V122 - Procedures for infection control. The facility must demonstrate that it follows standard infection control precautions by implementing-] [Maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-](ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. Based on observations, interviews, and document reviews, the facility failed to ensure patient care staff cleaned and disinfected the patient treatment station chair per facility policy in two of three observations of dialysis station cleaning. Specifically, staff did not fully recline the dialysis chair to ensure all surfaces were cleaned. Additionally, the facility failed to ensure the dialysis station bleach cleaning solution was labeled per facility policy to ensure its efficacy in two of two observations of the patient care area.”

“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 observation and interviews, the facility failed to ensure two of three 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 Infection Control for Dialysis Facilities policy read, the purpose of this policy is to minimize the spread of infections or bloodborne pathogens in the dialysis facility environment. Patients and caregivers will be encouraged to perform hand hygiene after treatment before leaving the treatment area. 1. The facility failed to ensure patients performed hand hygiene following the removal of soiled gloves. A. Observations i. On 7/15/24 at 9:58 a.m., an observation was conducted at station #6. The patient was observed holding pressure to their own site with a gloved right hand following the removal of the needles used for treatment. At 10:05 a.m., after stabilization of the site, a staff member 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 returned to station #6, informed staff of their weight and left the facility. Staff did not educate or request the patient to perform hand hygiene following the glove removal. ii. On 7/16/24 at 10:32 a.m., an observation was conducted at station #7. The patient was observed with two clamps on their right arm which were used to hold pressure to their access site following the removal of the needles used for treatment. The patient was observed touching the clamps with an ungloved left hand. The patient then ambulated to the scale and obtained their weight by touching the scale button with their left hand, then returned to station #7 and packed their belongings. At 10:50 a.m., after stabilization of the site, a staff member applied a dressing to the site, and walked the patient to the exit. Staff did not educate or request the patient perform hand hygiene before leaving the facility. B. Interviews i. On 7/17/24 at 11:05 a.m., an interview was conducted with patient care technician (PCT) #2. PCT #2 stated after the patient’s access site was stabilized, the patient was to remove their glove and perform hand hygiene. PCT #2 stated there was a risk of the patient having blood on their hand which could have been an infection risk. ii. On 7/17/24 at 12:29 p.m., an interview was conducted with PCT #3. PCT #3 stated after a patient’s access sites were stabilized, patients were to perform hand hygiene before going to the scale. 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 HIV, hepatitis and other viruses. iii. On 7/17/24 at 10:08 a.m., an interview was conducted with registered nurse (RN) #1. RN #1 stated after the patient’s access site was stabilized the patient was to perform hand hygiene. RN #1 stated if a patient did not perform hand hygiene after glove removal there was a risk of infection such as hepatitis.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 45020 Based on observations, interviews, and document reviews, the facility failed to ensure patient care staff cleaned and disinfected the patient treatment station chair per facility policy in two of three observations of dialysis station cleaning. Specifically, staff did not fully recline the dialysis chair to ensure all surfaces were cleaned. Additionally, the facility failed to ensure the dialysis station bleach cleaning solution was labeled per facility policy to ensure its efficacy in two of two observations of the patient care area. Findings include: Facility policies: The Infection Control for Dialysis Facilities policy read, the purpose of this policy is to minimize the spread of infections or blood borne pathogens in the dialysis facility environment. At the end of each treatment, the dialysis station will be cleaned and disinfected. Surfaces to disinfect include but are not necessarily limited to all surfaces in contact with the patient or their belongings (e.g., dialysis chair). Use an appropriate disinfectant such as 1:100 (one to one hundred) bleach solution for routine disinfection of environmental surfaces. Disinfection should be completed by using a wiping motion with friction. Sufficient disinfectant should be applied so that surfaces are visibly wet. Surfaces should be allowed to air dry in order to provide sufficient disinfectant contact time. The Preparation of One to One Hundred (1:100) Bleach Solution policy read, with indelible marking pen and label, label container with expiration date, time and initials. The solution is good for 24 hours only. The Preparation of One to One Hundred (1:10) Bleach Solution policy read, with indelible marking pen and label, label container with expiration date, time and initials. The solution is good for 24 hours only. Reference: According to the manufacturer’s instructions for use for Pure Bright germicidal ultra bleach, for sanitizing non-porous surfaces, prepare a solution of this product, wash surface, let stand 5 minutes to air dry. 1. The facility failed to ensure dialysis chairs were cleaned and disinfected between patient treatments according to facility policy. Direct patient care staff did not place the dialysis chair into the fully reclined position to ensure all surfaces of the chair were cleaned. A. Observations i. On 7/15/24 at 9:38 p.m., patient care technician (PCT) #4 was observed as they disinfected the dialysis chair at station #4. PCT #4 wiped all visible surfaces of the chair with a bleach solution and opened the side arm rests to clean the surfaces in between the chair and the arm rest, however, they did not place the chair into a fully reclined position to wipe the crevices of the chair seat. PCT #4 completed disinfecting the dialysis chair, removed their gloves, and performed hand hygiene. When asked if the chair was fully reclined, PCT #4 used a lever on the back of the chair and fully reclined the chair at this time. The dialysis chair was then left fully reclined, however the crevice was not cleaned after the chair was fully reclined. ii. On 7/15/24 at 10:10 a.m., PCT #5 was observed as they disinfected the dialysis chair at station #6. PCT #5 wiped all visible surfaces of the chair with a bleach solution and opened the side arm rests to clean the surfaces in between the chair and the arm rest, however, they did not place the chair into a fully reclined position to wipe the crevices of the chair seat. PCT #5 completed disinfecting the dialysis chair, removed their gloves and performed hand hygiene. When asked if the chair was fully reclined, PCT #5 stated they were unsure if the chair was fully reclined. PCT #5 used a lever on the back of the chair and fully reclined the chair at this time. The dialysis chair was then left fully reclined, however the crevice was not cleaned after the chair was fully reclined. B. Interviews i. On 7/17/24 at 12:29 p.m., an interview was conducted with PCT #3. PCT #3 stated dialysis chairs were to be cleaned after use. PCT #3 stated dialysis chairs were to be fully reclined with a lever on the back of the chair, and the side arms were to be opened to be cleaned. PCT #3 stated all surfaces of the dialysis chair were expected to be cleaned and the dialysis chair was to be left reclined with the side arms open until dry. PCT #3 stated dialysis chairs were cleaned after each patient use to prevent risk of germs and viruses which could cause infection. ii. On 7/17/24 at 10:08 a.m., an interview was conducted with registered nurse (RN) #1. RN #1 stated dialysis chairs were to be fully reclined with a lever on the back of the chair, and the side arms were to be opened to be cleaned. RN #1 stated all surfaces of the dialysis chair were expected to be cleaned and the dialysis chair was to be left reclined with the side arms open until dry. RN #1 stated if dialysis chairs were not cleaned there was an infection risk to the patients. 2. The facility failed to ensure patient care staff prepared the bleach solution used to clean patient chairs, dialysis machines and supplies used in patient care according to facility policy. Specifically, the bleach containers were not labeled with the date, time and initials which identified when the bleach solution was prepared. A. Observations i. On 7/15/24 at 9:42 a.m., the patient care area was observed. Two containers filled with a solution were observed on the countertop in front of station #11. The containers had labels on them indicating they were filled with a bleach solution, however, there was no documentation of the date and time of when the bleach solutions were prepared or which staff member mixed the solution. During the observation, patient care technician (PCT) #6 stated they had prepared the bleach solutions this morning but had not labeled the containers with the date and time of preparation. PCT #6 stated it was important to label bleach solutions because the bleach was not as effective after 24 hours. ii. On 7/15/24 at 10:29 a.m., a staff member was cleaning the dialysis chair at station #3. The staff member was observed getting bleach rags from two unlabeled bleach containers on the countertop by station #3. The staff member was unable to answer when the bleach solution had been prepared. B. Interviews i. On 7/17/24 at 11:05 a.m., an interview was conducted with PCT #2. PCT #2 stated 1:100 bleach solutions were used to clean patient chairs and dialysis machines after each use and 1:10 bleach solution was used if blood was visible. PCT #2 stated it was important for a label to be placed on the containers with the date and time it was prepared because the bleach solutions were not as effective after 24 hours and might not have cleaned surfaces effectively, which could have had viruses present. ii. On 7/17/24 at 10:08 a.m., an interview was conducted with registered nurse (RN) #1. RN #1 stated bleach solution containers were to be labeled at the time they were prepared. RN #1 stated bleach containers were to be labeled because bleach could lose effectiveness and there was a risk of germs, which could cause infection.”