Dci Lafayette

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 32734 Based on observation, a review of the Centers for Disease Control and Prevention (CDC) guidelines, staff interviews, review of NKF KDOQI (National Kidney Foundation Kidney Disease Outcomes Quality Initiative) Vascular Access Guideline, and a review of facility policy and procedures, it was determined that the Infection Control Committee failed to ensure that one of one Registered Nurse (RN AA) observed during initiation and termination of hemodialysis (HD) treatment on one of one patient observed who had Central Venous Catheter (CVC - a flexible tube that was inserted into a vein, and was guided/threaded into a large vein above the right side of the heart called the superior vena cava), utilized appropriate infection control techniques to prevent cross contamination. This breach in infection control techniques could negatively affect the health and safety of P#10, and all other patients who had CVC, as their dialysis access. The facility census was 44. Findings include: During observation in the Patient Treatment Room on 8/21/24 between 11:00 a.m. and 3:30 p.m., the following was observed: - On 8/21/24 at 2:47 p.m., RN AA was observed during initiation of hemodialysis treatment on P#10, who had a CVC at Station (S) 10. RN AA withdrew blood from the ports and placed the blood filled syringes onto the clean fileld on top of the sterile dressing, then picked up the dressing and applied it to the exit site. RN AA failed to change gloves between tasks. According to the CDC, cross contaminating (going from dirty to clean equipment/tasks/area), could cause the spread of bacteria/infections. During an interview with RN AA at 2:59 p.m., she was asked if was she aware that she had placed the blood filled syringes on the clean field with the sterile dressing, she stated, “I didn’t think about it at the time”.”

“PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This Standard is not met as evidenced by: 32734 Based on observations and staff interviews, it was determined that the facility failed to maintain a safe building and a clean environment for patients and staff. These environmental concerns were observed in one of one Supply Room/Water Room. The facility census was 44. Findings include: During a tour of the facility with the Clinical Manager on 8/21/24 at 11:00 a.m., the following was observed: In the Supply Room/Water Room: - There was a 12 inch long x 1 inch high gap at the bottom of the door to the floor that opens from the supply room to the outside. - Rust and erosion on the bottom of the metal frame of the door. - There were black scuff marks throughout on the supply room floor. - The baseboard was separated from the wall on the left side (approximately six to eight inches in diameter) near the door leading to the Water Room. - The drain located in front of the acid holding tank was clogged with dirt and debris. - There were peeled floor finish in front of the acid holding tank During a discussion with the Clinical Manager and Biomed Manager on 8/21/24 at 12:00 p.m and with the Director of Operations on 8/22/24 at 2:00 p.m., all acknowledged the above findings.”