Fresenius Medical Care St. Marys

“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: 49321 Based on observation and staff interview it was determined that the Infection Control Committee failed to ensure that one of one Patient Care Technician (PCT AA) observed, utilized appropriate infection control techniques to prevent cross contamination. This deficient practice had the potential to negatively affect the health and safety of all patients who dialyzed at Station (S) 11, S12, S13, and S14 at the time of this observation. The facility census was 52. During observation in the Patient Treatment Room on 6/4/24 from 10:50 a.m. - 11:30 a.m., the following was revealed: - The clean area designated for PCT AA, who was assigned to care for patients at Station (S) 11, S12, S13, and S14, had four strips of tape (each strip had four pieces of tape layered on top of each other - used to secure dressing over patient’s access sites after dialysis) that was stored on a clean blue pad. There was a cell phone, used/contaminated gloves that were turned inside out, and an alcohol pad wrapper that were left on top of the the clean strips of tape. - A tall biohazard container that contained contaminated/discarded blood lines was stored tightly alongside the clean area. - At 11:00 a.m., the Clinic Manager moved the tall biohazard container away from the clean area. The PCT picked up his cell phone and put it in his pocket while he wore contaminated gloves. During an interview with PCT AA on 6/4/24 at 11:30 a.m., he stated “I was in a hurry to get the next patient’s dialysis treatment started. I know cell phones are not suppose to be on the treatment floor, but I forgot it was up there”.”

“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: 49321 Based on observation and staff interview, it was determined that the Infection Control Committee failed to ensure that one of one Registered Nurse observed (RN AA), utilized appropriate infection control techniques to prevent cross contamination. This breach in infection control techniques could negatively affect the health and safety of Patient (P) #1 and all other patients who had Central Venous Catheter (CVC - a thin flexible tube that is inserted into a vein, usually below the right collarbone, and guided into a large vein above the right side of the heart), as their dialysis access. The facility census was 52. Finding were: During observation in the Patient Treatment Room on 6/4/24 from 10:50 a.m. - 11:30 a.m., the following was revealed: - RN AA was observed initiating dialysis on P#1, who had a CVC. RN AA removed the old CVC dressing, discarded the dressing, removed gloves, donned a new pair of gloves and then applied a new CVC dressing. RN AA did not performed hand hygiene (wash hands or use a hand sanitizer) after removal of gloves and prior to donning each new pair of gloves. When RN AA cleaned the CVC site and aspirated blood from the catheter, she returned the contaminated supplies and syringes to the blue pad that held the clean supplies. This deficient practice could lead to an intravascular catheter-related infection. During an interview on 6/4/24 at 11:35 a.m., RN AA stated she did not realize she had not used a hand sanitizer. She stated that she forgot the skin cleaning solution and had to walk over to the nurses area to get it. She stated, “this may be when I changed gloves”. RN AA was aware that she put the contaminated/used supplies on the blue pad that held clean supplies and stated “I put them in the clear bag before discarding them”. A review of the CDC Guidelines for Preventing Intravascular Catheter-Related Infection, dated 2011 stated: Perform Hand Hygiene procedure either by washing hands with conventional soap and water or with alcolhol-based hand rubs. Hand hygiene should be performed before and after palpating catherter insertion site as well as before and after inserting, replacing, accessing, repairing or dressing an intravascular catheter.”