Davita Harden 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 observations, interviews and record review the facility failed to follow standard infection control practices and facility policies related to performing hand hygiene between glove changes, before performing any invasive procedures, and after contact with inanimate objects for 5 of 10 sampled patients (#6, #10, #11, #12, #13). Findings included: On 08/06/2025 at 9:50 a.m. Staff B, Registered Nurse (RN) was observed laying heparin filled syringes on the computer desk between Stations 5 and 6. Staff B, RN sanitized her hands and applied gloves. Staff B picked up the syringes and entered the isolation room and laid the syringes on Patient #13’s sterile barrier. After cleaning the ports Staff B, RN administered the heparin. Staff B, RN disposed of the used syringes in the sharp container. On 08/06/2025 at 9:00 a.m. Staff A, Patient Care Technician (PCT) was observed touching Patient #12 at Station 10 clothes with her gloved hands. Staff A removed the first dialysis cannulation needle and applied gauze. Staff A, PCT removed her gloves, sanitized her hands and input into the computer. Staff A, PCT then applied gloves and moved the biohazardous container closer to the patient using her gloved hands. Staff A removed the second cannulation needle with the same gloves. Staff A placed a gauze on the second needle site. Staff A removed her gloves, moved the biohazardous container back around to the other side of the patient and sanitized her hands. During an interview on 08/06/2025 at 10:55 a.m. with the Clinical Manager and the Regional Manager of Clinical Services stated the nurse should not lay syringes on the computer area, especially the computer not assigned to the patient the heparin was for. The computer areas are clean but only if infection control is followed to not contaminate them with contaminated hands or gloves. The staff was to hand sanitize before using the computer system and hand sanitize prior to reapplying gloves. The nurse should not have laid the syringes down on the patient’s sterile field after being on another’s computer. They stated that the rolling biohazard box was contaminated and dirty. On 08/06/2025 at 10:15 a.m. Staff A, PCT was observed at Station 14 with Patient #10 with her gloves on, she adjusted his blood pressure cuff. She then input into the computer system. Staff A removed her gloves but did not sanitize her hands. Staff A reapplied gloves and inputted into Patient #10 at Station 14’s dialysis machine. Staff A removed her gloves and reapplied gloves. Staff A walked to Station 9 where Patient #6 was sitting and removed her gloves and reapplied 1 glove and input into Patient #6’s dialysis machine. Staff A walked from Station 9, back to Station 14 where Patient #10 was sitting. Staff A applied both gloves. Staff A touched Patient #10 and his TV remote. Staff A removed her gloves and sanitized her hands. Staff A ambulated to Station 12 where Patient #11 was sitting and inputted into the computer. Staff A applied gloves. Staff A , PCT was then walking around the treatment floor area with her gloves on, touching blood pressure cuffs, etc. Staff A returned to Patient #11 at Station 12 where she removed her gloves and without sanitizing her hands, she applied the blood pressure cuff to Patient #11. Staff A applied her gloves and went to the center desk area and picked up her face shield and applied it. Staff A returned to Station 12 and Patient #11 with a stool in tow. Staff A palpated the fistula site. Staff A obtained a stethoscope from the center desk area without cleaning it. Staff A checked Patient #11’s bruit (an audible vascular sound associated with turbulent blood flow) with the stethoscope. Staff A returned the stethoscope to the center desk area without cleaning it. Staff A cleaned the fistula area with antiseptic. Staff A removed her gloves. Staff A went to the desk area and sanitized her hands. Staff A came back to Patient #11 and inputted into the computer. Staff A applied gloves without sanitizing her hands. Staff A cleaned the fistula area again and “fanned” the area with a gauze pad package. Staff A cleaned the area with antiseptic a second time and “fanned” the area again. Staff A applied betadine to the fistula. Staff A removed her gloves. Staff A inputted into the computer. Staff A sanitized her hands. Staff A applied gloves and inserted the cannulating needle times 2. The nurse came over and administered heparin. Staff A, PCT removed her gloves and washed her hands. During an interview on 08/06/2025 at 11:05 a.m. with the Clinical Manager and the Regional Manager of Clinical Services stated the staff was expected to hand sanitize between glove changes. The staff was to never “fan” the access post cleaning. The staff was expected to hand sanitize or wash their hands between patients. The staff was expected to hand sanitize before and after using the computer. A stethoscope or any reusable equipment was to be cleaned before and after each use. Review of the facility’s policy, “Infection Control for Dialysis Facilities,” revised April 2023 showed the purpose to minimize the spread of infections or blood borne pathogens in the dialysis facility environment. Hand hygiene ...All teammates, physicians and non-physician (NPP) will perform hand hygiene: Upon entering and exiting the patient treatment area; Prior to gloving and immediately after removal of gloves; After contamination with blood or other infectious material; After patient and dialysis delivery system contact; Between patients even if the contact is casual; Before touching clean areas such as supplies, supply cart and chair side keyboard / mouse... Appropriate PPE will be worn whenever there is the potential for contact with body fluids, hazardous chemicals, contaminated equipment and environmental surfaces, for example, patient care areas. PPE is to be: Removed prior to leaving the treatment area; Removed as soon as possible if overly contaminated and ii. Non-disposal, properly disinfect and placed in designated area; 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; Gloves should be changed when: When soiled with blood, dialysate or other body fluids; When going from a “dirty” area or task to a “clean” area or task; When moving from a contaminated body site to a clean body site of the same patient; And 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 Measures will be taken to prevent cross-contamination between patients. Medication vials, syringes, tape alcohol swabs, gloves, or other supplies will not be carried in pockets. Electronic thermometers and / or blood glucose meters should not be placed on potentially contaminated equipment such as the dialysis delivery system. Disinfection. Cleaning and / or disinfection of equipment and work services will be performed as soon as possible following exposure to blood or other potentially infectious materials and prior to returning to clean/ designated area or removal from treatment area. Dialysis delivery systems with computers / keyboards mounted on top, the computer and keyboard are considered “dirty” equipment. Non-disposable items are to be disinfected after each patient, prior to removal from treatment area / station and if contaminated between uses. Stethoscopes will be disinfected with alcohol prep pad and / or 1:100 bleach solution and if they are visibly contaminated with blood or body fluids should be disinfected with a 1:10 bleach solution. The chair side cart, Terminals mounted on the counter, monitoring keyboards are considered clean areas. The chair side cart components will be cleaned at the end of each treatment day. Sharps containers are not stored on the chair side cart.”

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 42154 Based on observations, policy and interviews it was determined the facility failed to minimize the potential transmission of blood borne pathogens by using multi-dose antibacterial exit site cleaner for more than one patient in 1 (Patient #8) of 2 Central Venous Catheter (CVC) exit site dressing changes observed. Findings included: Review of the facility policy and procedures titled, “Infection Control for Dialysis Facilities”, # 1-05-01, revision 04/2023 ...Clean area should be clearly designated for the preparation, handling, and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled ... A tour of the dialysis unit on 08/06/2025 at 9:07 AM observed Staff D, PCT cleaned around the Central Venous Catheter (CVC) exit site of Patient #8 with antibacterial exit site cleanser for multiple use. After removing blood from the patient’s CVC lines and disposed of the syringes into the biohazard sharp container, no hand hygiene performed before the antibacterial container was moved from the chairside to the computer. During a discussion on 08/07/2025 at 9:37 AM with the Administrator in which she disclosed that the antimicrobial exit site cleanser is dirty and should not have been brought to the station. During a discussion on 08/07/2025 at 10:15 AM the Regional Manager Clinical Services disclosed that the antimicrobial exit site cleanser (Sodium Hypochlorite-disinfectant) is for patients that are allergic to the chlorohexidine (antiseptic and disinfected agent to reduce bacteria that can cause infections) site cleanser. The staff is using because they told her that the patient prefers the antimicrobial exit site cleanser over the chlorohexidine. Photo evidence obtained.”

“IC-HANDLING INFECTIOUS WASTE CFR(s): 494.30(a)(4)(i) [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- (i) Handling, storage and disposal of potentially infectious waste; This Standard is not met as evidenced by: 42154 Based on policies, observations and staff interviews, the facility did not ensure the patient Dialysis treatment area was free from spread of potentially infectious waste by failing to secure open acid jugs leaving the fluid open to the elements, in 5 (Stations 3, 9, 10, 15, 16) of 8 acid jug containers (Dialysis acid jugs contain a concentrate of acid that is used to mix with bicarbonate to create dialysate.) Findings included: Review of policy Utilizing acid concentrate in Containers, # 1-06-02A, revision 09/2024 ...Upon opening an acid concentrate container label container with date opened, and initials of teammates. Connect the dialysis delivery systems acid concentrate line to the wand connector ...Partially used acid concentrate containers should be wiped with an appropriate disinfectant prior to returning to storage area ... On 08/06/2025 at approximately 8:30 AM a tour was conducted, observed station #3, station # 10, station #15 and station #16 all with unsecured dialysate jug lids, leaving them open to air and contaminates. On 08/06/2025 at 9:46 AM an acid jug changed by Staff B, RN, at station #9, had an unsecured top, leaving it open to air and contaminates, and on the floor. On 08/07/2025 at 8:21 AM during a tour of the dialysis unit, 2 used, half filled acid jug containers were noted above a clean sink, with no date of when the jugs were opened and no staff initials. During discussion on 08/06/2025 at approximately 10:30 AM with the Regional Manager Clinical Services regarding the photo evidence of the unsecured acid jugs and she disclosed that the lids should be secured. During a discussion on 08/07/2025 at approximately 9:30 AM with the Regional Manager Clinical Services regarding photo evidence of the jugs that were open and on the clean sink, she stated there should be a date and initials when the jug is opened. Photo evidence obtained.”