Davita Orange City 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 1 (#9) of 2 patients observed during Discontinuation of hemodialysis and post-dialysis access care with an AVF (Arteriovenous Fistula). Findings include: On 5/19/25 at 10:58am, discontinuation of hemodialysis and post-dialysis access care was observed of Patient #9 at Station 8. Staff #A, a Patient Care Technician (PCT), removed the soiled tubing from the hemodialysis machine, discarded the tubing into a biohazardous waste container, removed gloves, and donned new gloves without performing hand hygiene. Staff #A walked to Station #6 and adjusted the blood pressure cuff on the patient’s arm. Staff #A then adjusted the tubing on the hemodialysis machine at Station #6, performed the external pH (potential of hydrogen) testing, removed gloves, and donned new gloves without performing hand hygiene. Staff #A returned to Station #8 and touched the hemodialysis machine to silence an alarm. Staff #A removed his gloves, and donned new gloves without performing hand hygiene, then returned to Station #6 to begin initiation of hemodialysis. At 11:04am, Staff #A was stopped by the surveyor and told he had not performed hand hygiene between the three gloves changes. Staff #A responded “Ok” and performed hand hygiene using an alcohol-based hand sanitizer. At 11:13am, Staff #A was observed touching the hemodialysis machine at Station #4 to silence an alarm. Staff #A removed his gloves and donned new gloves without performing hand hygiene and began to assist the patient at Station #5 with their CVC (Central Venous Catheter) exit site dressing. During the interview with the Manager of Clinical Services on 5/19/25 at 11:15am, it was confirmed that staff members must perform hand hygiene between every glove change. The facility policy titled “Infection Control for Dialysis Facilities,” revised April 2023, states “1. All teammates, Physicians and Non-Physician (NPP) will perform hand hygiene a. upon entering and exiting patient treatment area; b. prior to gloving and immediately after removal of gloves; c. after contamination with blood or other infectious material; d. after patient and dialysis delivery system contact; e. after interacting with wall boxes; f. between patients even if the contact is casual; g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse.””

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 35966 Based on observation and staff interview, the facility failed to follow prescribed orders for hemodialysis for 1 (#7) of 4 patients observed. The findings include: Observation of the hemodialysis machine setup for Patient #7 on 5/20/25 at 1:14pm revealed that the patient was running on a dialysate bath of “2 K (potassium) 2.5 Ca (Calcium)”. Electronic review of the physician orders revealed that the physician ordered a dialysate bath of “2 K 2 Ca”. During the interview with the Nurse (Staff D) on 5/20/25 at 1:20pm, it was confirmed the patient was set up on the wrong dialysate bath. The facility policy titled “Pre-intra-post treatment data collection, monitoring, and nursing assessment” revised April 2024 states “3. Patient identity, prescription and machine settings are verified by teammate prior to initiation of treatment with the exception of blood flow rate which is verified and documented when the ordered rate is obtained after onset of treatment. The prescription components are confirmed by a licensed nurse within one hour of treatment initiation along with he nursing assessment or as allowable by state law. Prescription components include but are not necessarily limited to: a. dialyzer make and model; b.treatment time; c. target weight; d. UFR and Max UFR; e. UF profiling; f. blood flow rate; g. dialysate flow rate; h. all accesses evaluated; i. correct dialysate composition (potassium, calcium, base sodium, and bicarb) and setting; j. heparinization (intradialytic infusion setting).””