Davita Palm Coast Dialysis

“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: 35966 Based on observations and staff interviews, the facility failed to perform Infection Control Practices for 2 (#14 and #15) of 2 patients observed during Initiation of Central Venous Catheter (CVC) and Exit site care and Discontinuation of CVC site care. Findings include: 1. An observation on 5/5/25 at 1:25 p.m. of Staff A, Registered Nurse (RN) performing Central Venous Catheter (CVC) care for Patient #14 at station 8. Staff A did not perform hand hygiene before donning gloves prior to the discontinuation care of the CVC site. Staff A pulled supplies from the drawer and did not remove gloves and performed no hand hygiene. Prior to closing the CVC clamps and disinfecting CVC connections, Staff A removed gloves and reapplied gloves, pulled supplies from the drawer, and reapplied new gloves without hand sanitizing. With the same gloves, Staff A picked up the stethoscope from the table and did not clean the stethoscope prior to using with the patient. Staff A walked the patient to the door, opened the door wearing the same gloves and performed no hand hygiene or removal of gloves. During the interview with Staff A on 5/5/25 at 1:50 p.m, he stated he would be more careful when told that he was observed not following infection control practices. 2. An observation on 5/5/25 at 3:18 p.m. of Staff B, Licensed Practical Nurse (LPN) performing Central Venous Catheter (CVC) care for Patient #15 at station 14. Prior to applying sterile port caps aseptically after post treatment protocol, Staff B removed gloves and performed no hand hygiene prior to updating patient data on the computer. Staff B assisted Patient #15 with putting on her shoes, removed gloves and reapplied gloves and performed no hand hygiene. 3. An observation on 5/5/25 at 11:40 a.m. of Staff B, Licensed Practical Nurse (LPN) performing Central Venous Catheter (CVC) care for Patient #15 at station 14. Staff B began care of the CVC exit site by donning gloves and removing the old dressing. Staff B did not remove gloves and perform hand hygiene prior to cleansing the area around the CVC exit site with antiseptic. Staff B then used the gauze packaging to fan the exit site area dry. Sterile dressing was applied to the exit site before she began disinfection of the exterior catheter hubs. She removed the caps from the two hubs and withdrew blood into syringes then left them attached to the patient’s ports. She removed her gloves and reapplied them without hand sanitizing. Staff B removed one syringe with blood in it, cleaned the port, and flushed the port with saline. She then removed the second syringe with blood in it, cleaned the port, flushed it with saline. She removed her gloves, replaced her gloves, and connected the patient to the dialysis machine. During the interview with Staff B on 5/5/25 at 11:52 am, she stated “ok, whatever” when told that she was observed not following infection control practices. The facility policy titled “Central Venous Catheter (CVC) with Clearguard HD Antimicrobial End Caps Procedure” last revised April 2025 states “1. Perform hand hygiene per procedure. Put on PPE and provide a mask to the patient. 2. If teammate performing this procedure assisted the patient to put on their face mask, re-perform hand hygiene per procedure and put on clean gloves. 3. Place patient in comfortable supine position, as flat as possible. 4. Remove old dressing and discard. 5. Observe site for signs and symptoms of infection. 6. Verify that both arterial and venous catheter limbs are clamped. 7. Remove gloves and discard. Perform hand hygiene per procedure and re-glove. 8. Holding catheter with the non-dominant hand and using aseptic technique, clean exit site with 2% chlorhexidine gluconate/70% isopropyl alcohol swab for a minimum of 30 seconds then wait 60 seconds for air dry time. 9. Clean each CVC limb/cap with a new large alcohol prep pad, starting close to the exit site and finishing with the cap. 10. Remove gloves and discard, perform hand hygiene and re-glove.” The policy continues to state: “16. Verify both catheter clamps are closed. Using aseptic technique, remove each cap. One at a time, disinfect each CVC hub with a new alcohol prep pad. Scrub each CVC hub for 15 seconds including the sides, threads, and end of hub thoroughly with friction making sure to remove any residue. 17. Attach sterile 10 ml syringes to the arterial and venous limbs. 18. Open the catheter clamps. Aspirate an amount greater than the catheter limb lumen, generally about 5 ml from each limb.” The policy continues “ 21. Aseptically discard syringe containing indwelling solution from arterial limb and attach a saline filled syringe. Repeat step for venous limb.” Upon completion of dialysis the policy states “28. Discard used barrier that was used during treatment and place a new clean, moisture proof barrier under catheter to prevent contamination. 29. Remove gloves and discard, perform hand hygiene per procedure and re-glove. 30. Clamp arterial catheter limb and blood line. Aseptically disconnect arterial blood line from arterial CVC limb. Attach a 10 ml syringe filled with normal saline to arterial catheter limb. Unclamp arterial catheter limb and push normal saline into arterial port and quickly clamp arterial limb. 31. Remove gloves and discard, perform hand hygiene and re-glove.””

“IC-HBV-ISOLATION-MACHINES/EQUIP/SUPPLIES CFR(s): 494.30(a)(1)(i) Isolation of HBV+ Patients To isolate HBsAg positive patients, ... dedicate machines, equipment, instruments, supplies, and medications that will not be used by HBV susceptible patients. This Standard is not met as evidenced by: 35966 Based on observation, interview and facility policy, the facility failed to ensure all employees entering the Isolation Room of Hepatitis B positive patients wear full Personal Protection Equipment (PPE) upon entering and exiting the Isolation Room. (Employee #D). Failure to wear PPE in the Isolation Room of a Hepatitis B positive patient could inadvertently expose the employee and other patients and employees to potentially infectious Hepatitis B infection. The findings include: An observation on 5/7/25 at 8:55am of Employee #D, Physician, showed she was speaking to hemodialysis patients on the treatment floor while wearing a white long-sleeved fluid resistant/fluid impervious gown. At 8:59am, the physician (Employee #D) entered the Isolation Room of a Hepatitis B positive patient while wearing the same gown . While speaking with the patient, she placed her right hand on the hemodialysis machine. She did not sanitize her hands or don any gloves before touching the hemodialysis machine. She spoke to the patient and exited the isolation room at 9:01am. She sat down at her rolling cart that held her computer and began typing without performing hand hygiene or removing the gown. During an interview on 5/7/25 at 9:10am with Employee A (Registered Nurse) it was stated that he informed the physician of the surveyor observations with her response being “they’re right”. The facility policy titled “Hepatitis B Surveillance, Vaccination, Infection Control Measures and Isolation Guidance” last revised April 2024 states “When entering the isolation room/area or station for any reason, physicians, NPPs, social workers, dietitians, and all other teammates will wear long-sleeved fluid resistant/impervious gowns in addition to gloves, face shield or mask and eye protection. The long sleeved gown will be tied in the back and gloves will be pulled over the cuffs of the sleeves. PPE (personal protective equipment) will be removed, gloves discarded, and hand hygiene performed immediately when leaving the room or area.””

“ENVIRONMENT-SECURE & RESTRICTED CFR(s): 494.40(a) 8 Environment: secure & restricted The water purification and storage system should be located in a secure area that is readily accessible to authorized users. The location should be chosen with a view to minimizing the length and complexity of the distribution system. Access to the purification system should be restricted to those individuals responsible for monitoring and maintenance of the system. This Standard is not met as evidenced by: 35966 Based on observation and interview, the facility failed to maintain restricted access to the water treatment area. The findings include: During the tour of the Water Treatment Room and Storage area on 5/5/25 at 10:42am, it was observed that the door to the room had a key pad that was not in use, and the door was not locked. The interview with the Facility Administrator on 5/5/25 at 10:34am confirmed that the door to the water room was not locked.”