Davita St Petersburg South 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: 34768 Based on observation, interview and record review the facility failed to follow infection control protocols related to donning and doffing of gloves, hand sanitizing for five of twelve sampled patients (Patient #8, #9, #10, #12, # 11). Findings included: During an observation on 05/02/2024 at 9:35 a.m. Staff J, Patient Care Technician (PCT) was performing discontinuation of arteriovenous fistula (AV) dialysis access for Patient #10. While her gloves were in place, she touched a stool but did not change her gloves or hand sanitize before continuing with care. There was no barrier on the chairside table, and she placed the sterile items on the table. The patient did not have a barrier under his arm. She changed her gloves during the procedure without hand sanitizing. The thermometer was used during the discontinuation and was placed on the computer at the patient’s station. She removed the patient’s oxygen; blood pressure cuff then removed her gloves and left the floor without hand sanitizing. On 05/02/2024 at 9:50 AM, an observation was performed of Staff H, RN, while caring for Patient # 12. Staff H touched the uncleaned hemodialysis machine of another dialysis patient who had left, to assessment of Patient #12 with same gloved hands, and without changing gloves and performing hand hygiene in between. During an observation on 05/02/2024 at 10:05 a.m. Staff B, PCT was performing Central Venous Catheter (CVC) Initiation care for Patient #8. Staff B, PCT donned and doffed her gloves throughout the procedure without consistently hand sanitizing between glove changes. She also removed her gloves, walked to a supply drawer, removed supplies, returned to the patient and reapplied gloves without hand sanitizing. After cleaning the CVC site, the patient’s shirt was allowed to touch the cleaned CVC site during the Exit Site Care. Staff B performed a blood draw, removed her gloves and applied gloves without hand sanitizing. During the initiation care Staff H, Registered Nurse (RN) was observed entering the patient’s area with gloves in place, removed his right glove and typed on the computer and replacing the right glove, without hand sanitizing. He was observed administering medication to Patient #8, removing his gloves, applying gloves and going to another station without hand sanitizing. On 05/02/2024 at 11:00 AM, an observation of Initiation of Dialysis of a Central Venous Catheter was observed on Patient #11. Staff H, Registered Nurse (RN) was noted wearing same gloves going from hemodialysis machine to hemodialysis machine with same gloves silencing alarms for different patients, preparing the dialysis machines, and checking acid and bicarb alarms. Staff H did not remove gloves or perform hand hygiene between each dialysis station. During an observation on 05/02/2024 at 10:18 a.m. Staff I, PCT was performing access to an arteriovenous fistula (AV) for Patient #9. Staff I did not change her gloves and hand sanitize after evaluating the access with a stethoscope. She did not place a barrier on the chairside table, placed the supplies on the table. After performing labs, she left the floor with her gloves on. Staff H, RN applied gloves without hand sanitizing, performed medication administration, (the ports were lying on the table due to a barrier not being in place), removed his gloves and left station without hand sanitizing. During an observation on 05/02/2024 at 2:05 p.m. Staff B, PCT was performing discontinuation of dialysis for Patient #8 with a CVC. Staff H, RN applied gloves, and placed a glove over the stethoscope and assessed the patient. He removed the glove from the stethoscope and his gloves. He did not sanitize the stethoscope nor his hands before leaving the station. During an interview on 05/03/2024 at 11:40 a.m. with the Facility Administrator and the Regional Registered Nurse (RN) they stated the staff was to hand sanitize between glove changes and when entering and exiting the treatment area. The staff was to wash their hands periodically also. A stethoscope was to be cleaned before and after each use. The thermometers should be cleaned after each patient if left at chair side. On review of the observations, the RN stated, “That was not good, they may need someone other than the Clinical Nurse to do the (infection control) audits at this time.” Review of the facility’s policy, “Infection Control for Dialysis Facilities,” revised on April 2023 showed the purpose was to minimize the spread of infections or bloodborne pathogens in the dialysis facility environment. Hand Hygiene: 1. All teammates, Physicians and Non-Physician (NPP) will perform hand hygiene. A. upon entering and exiting the patient treatment areas. B. prior to gloving and immediately after removal of gloves, C. after contamination with blood or other infectious materials. D. after patient and dialysis deliver 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. PPE: 7. Disposable gloves will be worn when caring for the patient or touching the patient’s equipment at the dialysis station, this will include patients and visitors assisting with procedures such as self-cannulation or holding access sites. A. Gloves must be changed when: iv. After touching one patient or their dialysis delivery system and before arriving to care for another patient or touch another patient’s dialysis delivery system. Supplies: 11. Measures will be taken to prevent cross contamination between patients. B. Electronic thermometers and / or blood glucose meters should not be placed on potentially contaminated equipment such as the dialysis delivery system. 14. Non-disposable items are to be disinfected after each patient use, prior to removal from treatment area / station and if contaminated between uses. A. Stethoscopes will be disinfected with alcohol prep pad and / or 1:100 bleach solution. 49691”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 49691 Based on observation, policy review, and interviews the facility failed to disinfect medical equipment used in the care of patients in 2 (Staff H, and Staff E) of 8 staff observations. Review of the facility’s policy, “Infection Control for Dialysis Facilities,” revised on April 2023 showed the purpose was to minimize the spread of infections or bloodborne pathogens in the dialysis facility environment. Hand Hygiene: 1. All teammates, Physicians and Non-Physician (NPP) will perform hand hygiene. A. upon entering and exiting the patient treatment areas. B. prior to gloving and immediately after removal of gloves, C. after contamination with blood or other infectious materials. D. after patient and dialysis deliver 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. PPE: 7. Disposable gloves will be worn when caring for the patient or touching the patient’s equipment at the dialysis station, this will include patients and visitors assisting with procedures such as self-cannulation or holding access sites. A. Gloves must be changed when: iv. After touching one patient or their dialysis delivery system and before arriving to care for another patient or touch another patient’s dialysis delivery system. Supplies: 11. Measures will be taken to prevent cross contamination between patients. B. Electronic thermometers and / or blood glucose meters should not be placed on potentially contaminated equipment such as the dialysis delivery system. 14. Non-disposable items are to be disinfected after each patient use, prior to removal from treatment area / station and if contaminated between uses. A. Stethoscopes will be disinfected with alcohol prep pad and / or 1:100 bleach solution. On 05/02/2024 at 9:50 AM, Staff H, RN (Registered Nurse) was observed while caring for Patient #12. Staff H, RN was observed using the stethoscope around his neck on Patient #12 without disinfecting prior to use on the patient. On 05/02/2024 @ 1010 AM, Staff E, RN , was observed during access of AV (arteriovenous) Fistula (internal dialysis access point for cannulation) for initiation of Dialysis. While assessing bruit and thrill of AV fistula, Staff E, RN utilized stethoscope from around his neck placing the stethoscope on patients Fistula without cleaning the stethoscope prior to use on the patient. During an interview on 05/03/2024 at 11:40 a.m. with the Facility Administrator and the Regional Registered Nurse (RN) they stated the staff was to hand sanitize between glove changes and when entering and exiting the treatment area. The staff was to wash their hands periodically also. A stethoscope was to be cleaned before and after each use. The thermometers should be cleaned after each patient if left at chair side. On review of the observations, the RN stated, “That was not good, they may need someone other than the Clinical Nurse to do the (infection control) audits at this time.””

“GOV-INTERNAL GRIEVANCE SYS ID/IMPLEMENTED CFR(s): 494.180(e) The facility’s internal grievance process must be implemented so that the patient may file an oral or written grievance with the facility without reprisal or denial of services. The grievance process must include- (1) A clearly explained procedure for the submission of grievances. (2) Timeframes for reviewing the grievance. (3) A description of how the patient or the patient’s designated representative will be informed of steps taken to resolve the grievance. This Standard is not met as evidenced by: 20536 Based on observation, interview, and record review, the facility failed to ensure an internal grievance procedure was in place to document patient concerns and ensure steps were taken to resolve the grievances for one (Patient #1) of 12 sampled patients. Findings included: On 5/2/24 at 9:40 a.m., Patient #1 was observed with Patient Care Technician (PCT) Staff J in the treatment area. Patient #1’s hemodialysis machine could be heard beeping. Patient #1 stated she arrived at 8:30 a.m. and had not received her treatment because the machine was broken. Staff H, Registered Nurse (RN), was observed to assist Patient #1 and attempt access to the patient’s left arm arteriovenous (AV) graft. On 5/2/24 at 9:44 a.m., Patient #1 stated, this keeps happening, and I need to leave if I’m not going to get my treatment. A telephone interview with Patient #1 on 5/2/24 at 10:49 a.m. revealed she had been receiving services from the facility for several years but had concerns for the past few months. Patient #1 reported the hemodialysis machines keep breaking causing her to miss treatments; the Director of Nursing (DON) curses in patient areas at the staff and sometimes at other patients; and nobody helped Patient #1 when she verbalized concerns to staff. Patient #1 stated she recently shared concerns with Staff J, PCT and Administrator, but she had not received any follow-up on her concerns. Review of Patient #1’s medical record revealed missed or shortened run times on 5/2/2024, 4/13/2024, and 4/11/2024. Review of the grievance/complaint log for the past 12 months revealed no concerns related to Patient #1. On 5/3/2024 at 10:00 a.m., the Administrator revealed she was familiar with Patient #1 and staff tried to accommodate the patient’s schedule as much as possible. The Administrator reported they allowed Patient #1 to come in later because of her childcare schedule. The Administrator confirmed Patient #1 had several complaints the past few months to include problems with the hemodialysis machines, no longer wanting receive services at this facility, and wanting assistance to transfer to another dialysis center. The Administrator had not received any concerns from other facility staff related to Patient #1 and had no knowledge of concerns with the DON’s behavior towards staff or patients. The Administrator confirmed there have been problems with the patient’s AV graft access, but not the facility’s equipment. The Administrator confirmed the patient has shortened her treatment times and becomes upset with the time it takes staff to safely gain access through her AV site. She confirmed that she should have identified this as a grievance and investigated with follow-up resolution to the patient. A request was made on 5/3/24 for the grievance/complaint policy and procedure, but no policy was provided.”