Fresenius Kidney Care Mcdonough

“IC-SINKS AVAILABLE CFR(s): 494.30(a)(1)(i) A sufficient number of sinks with warm water and soap should be available to facilitate hand washing. This Standard is not met as evidenced by: 32734 Based on observation and staff interview, it was determined that the facility failed to ensure that two of three handwashing sinks were in good working condition to facilitate handwashing for patients who were coming in for their hemodialysis (HD) treatment and for those patients who had completed their HD treatment, including all four Direct Patient Care (DPC) and ancillary staff who interacted with the patients on the treatment floor such as the social worker (SW), registered dietitian (RD), physicians, and the biomedical technician who repaired dialysis machines. This deficient practice had the potential to negatively affect all 46 in center hemodialysis (ICHD) patients, DPC and ancillary staff. Findings include: During a tour of the patient Treatment Room on 8/14/24 between 10:30 a.m. and 12:00 p.m., two of three sinks designated as “clean sink”, one located at the nurses’ station and one labeled “Patient Handwashing Sink” which were used for handwashing by the staff and patients, did not have warm running water for handwashing. The water in each sink failed to warm up after running for more than three minutes. During an interview with the clinical manager on 8/14/24 at 11:07 a.m., she acknowledged that the water in the sinks did not warm up.”

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 32734 Based on observation and staff interview, it was determined that the facility failed to ensure that one of one licensed staff (RNAA) observed, adhered to policy and procedure pertaining to medication preparation and administration. This deficient practice had the potential to negatively affect the health and safety of all 46 in center hemodialysis (ICHD) patients who received dialysis treatment at this facility. Findings include: During observations of the drawer of the medication cabinet located in the Treatment Room on 8/14/24 at approximately 10:40 a.m., surveyor found one 10 milliliter (ml) syringe and one three milliliter syringe filled with a clear colored liquid labeled Heparin (blood thinner). During an interview on 8/14/24 at 10:42 a.m., RN AA acknowledged the findings. No comment was made when asked why the medication was pre-drawn and in the cabinet drawer. A review of the facility’s policy titled “Medication Preparation and Administration for Inpatient Services”, Published 07/06/21; version 1 showed the following: Pg.3- Only one immediately administered medication may be drawn up and administered at a time. Immediately administered medications were prepared, directly brought to the patient, and administered by the same Fresenius Kidney Care (FKC) nurse without a break in the process.”

“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, 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 BB) observed during initiation and termination of hemodialysis (HD) treatment on one of one patient (seated at S5) 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 the patient seated at S5, and all other patients who had CVC, as their dialysis access. The facility census was 46 incenter hemodialysis (ICHD) patients and 17 peritoneal dialysis (PD) patients. Findings include: During observation in the Patient Treatment Room on 8/15/24 between 10:00 a.m. and 12:00 p.m., the following was observed: On 8/15/24 at 10:40 a.m., Registered Nurse (RN) BB was observed during initiation of hemodialysis treatment on a patient who had a CVC at Station (S5). - RN BB cleaned the CVC site starting from the inside closest to the exit site using an antiseptic swab (clean to dirty) then using the same antiseptic swab proceeded to clean from the outside of the exit site back towards the clean site. - RN BB placed a clean syringe on the tray table without a clean field. - RN BB dropped a syringe with normal saline on the floor, retrieved another syringe labeled normal saline from the opposite tray table on the right of the patient’s dialysis chair that was not lying on a clean field and placed it onto the clean field with clean supplies on the left side of the patient’s dialysis chair. - RN BB touched the machine (dirty) and keyboard, and then connected the patient’s hourly heparin syringe. RN BB then changed gloves. - RN BB proceeded to purge saline from the bloodlines, turned the blood pump on and then connected the bloodlines to the CVC lines while wearing the gloves she had just donned. RN BB failed to change gloves or sanitize hands between tasks. According to the CDC, cross contaminating (going from dirty to clean equipment/tasks/area), could cause the spread of bacteria/infections. A review of Procedure: 112 titled “Changing the Catheter Dressing Procedure”, Published 02/05/24; version 8 showed the following: Cleaning the site: -Step 1-Perform hand hygiene and don clean gloves -Step 2- Clean the exit site beginning in the center and continuing outward”