Davita Quitman Dialysis

“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: 50244 Based on observation, a review of policy and staff interview, it was determined that the facility failed to ensure that one of one Registered Nurse (RN) DD observed during initiation of dialysis treatment through a Central Venous Catheter (CVC - a large plastic tube placed in a vein in the neck or groin for exchange of blood to and from the hemodialysis machine during the hemodialysis treatment) access, adhered to facility policy pertaining to CVC. This deficient practice increased the relative risk for bacteremia (bacteria in the bloodstream) in patients with dialysis catheters, and had the potential to affect all current and future patients with CVC. Findings were: During observation in the Patient Treatment Room on 2/27/24 at 8:45 a.m., the following was revealed: - RN DD was observed initiating dialysis treatment on Patient #14 with a CVC access at Station 8. When cleansing the CVC insertion site, RN DD was observed completing the cleansing of the catheter exit site for 10 seconds. - When cleansing the CVC limb hubs (end of CVC that connects to the blood lines or cap), RN DD scrubbed each hub for 5 seconds only. A review of Policy 1-04-02B titled, “Central Venous Catheter (CVC) with Cleaguard HD Antimicrobial End Caps and Tegaderm CHG Dressing Procedure” dated October 2023 stated: For initiation of hemodialysis: Scrub each hub for 15 seconds including the sides, threads and end of hub thoroughly. Holding catheter with the non-dominant hand and using aseptic technique, clean exit site with 2% Chlorhexidine Gluconate 70% Isopropyl Alcohol swab for a minimum of 30 seconds. The above findings were discussed with RN DD on 2/27/24 at 9:00 a.m. She acknowledged not following the policy.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 50244 Based on observation, a review of facility policy, and staff interview, it was determined that the medical director failed to ensure that all Direct Patient Care Staff (DPCS) adhered to facility policy pertaining to vascular access care. This failure could lead to infection of the vascular access of seven of seven patients (P#4, P#6, P#8, P#9, P#10, P#12, and P#13) observed during discontinuation of treatment. The facility census was 35. During observation in The Patient Treatment Room on 2/27/24 between 8:30 a.m. - 10:30 a.m. and 11:30 a.m. - 12:30 p.m., the following was observed: - After dialysis, fistula needles were removed from P#4, P#6, P#8, P#9, P#10, P#12, and P#13’s cannulation (needle insertion) sites. - The sites were covered with gauze and tape, and pressure was applied to the cannulation sites. -After hemostasis (stopping of the flow of blood) was attained, the DPCS who were assigned to care for P#4, P#6, P#8, P#9, P#10, P#12, and P#13 did not discard the used gauze dressings but reinforced them with tape. - The DPCS did not apply new band-aid, adhesive dressing or gauze dressing over cannulation sites per facility policy, before the above mentioned patients were discharged. A review of Policy 1-04-01B titled, “Post Dialysis Vascular Access Care: Fistula/Graft Using Safety Fistula Needles” dated April 2023, stated: 13. Once bleeding has stopped, discard gauze or band-aid used to hold site. Inspect site for any trauma and for hemostasis. 14. Apply band-aid or sterile dressing over cannulation site. The above findings were discussed with the Facility Administrator on 2/27/24 at approximately 1:00 p.m.”