Usrc Oak Brook Dialysis

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [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-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 32741 A. Based on document review, observation and interview, it was determined that for 1 of 1 Patient Care Technician (E #2), the Facility failed to ensure the dialysis treatment chair was disinfected/cleaned, as required. Findings include: 1. On 7/15/2024, the Facility’s policy titled, “Disinfection and Cleaning of Dialysis Machine Equipment” (dated 7/2023) was reviewed and indicated, “Clean chair by placing in the reclining position and swing arms (if applicable) to clean seat, footrest, backrest and sides, armrest, inside of chair arms and chair frame and side tray tables...” 2. On 7/15/2024 from 8:45 AM until 11:00 AM, an observational tour was conducted in the in-center dialysis treatment area. The following was observed: -At 10:15 AM, E #2 was observed disinfecting/cleaning station #4. E #2 did not open side arms of the dialysis chair during disinfection. 3. On 7/15/2024 at 11:05 AM, an interview was conducted with E #2. E #2 stated that all areas of the dialysis chairs need to be cleaned. E #2 stated that the side arms need to be opened. B. Based on document review, observation and interview, it was determined that for 1 of 2 Patient Care Technicians (E #2) and 1 of 1 Registered Nurse (E #3) observed for handwashing, the staff failed to demonstrate knowledge of the Facility’s infection control practices by not performing proper handwashing, as required. Findings include: 1. On 7/15/2024, the Facility’s policy titled, “Hand Hygiene” (dated 8/2020) was reviewed and indicated, “Hand Hygiene will be performed before and after touching a patient before and after touching a patient, prior to entering and on exiting station to provide care to patient, prior to contact with vascular access site, after touching patient surrounding (e.g. dialysis machine, any items in the dialysis area or chairside computers)...” 2. On 7/15/2024, between 8:45 AM and 11:00 AM, an observational tour was conducted in the in-center dialysis treatment area. The following was observed: -On 7/15/2024 at 9:55 AM, a Patient Care Technician (E #2) touched the dialysis machine at station #8 then went to provide patient care at station #5 without performing any hand hygiene (no handwashing or sanitizing hands). -On 7/15/2024 at 10:30 AM, a Registered Nurse (E #3) did not perform hand hygiene or change gloves after touching a patient’s mask at station #4 and then immediately performed CVC site care at station #4. 3. On 7/15/2024 at 11:10 AM, an interview was conducted with the Patient Care Technician (E #2). E #2 stated that handwashing need to be after touching a dialysis machine and between each patient contact.”

“IC-TRAINING & EDUCATION CFR(s): 494.30(a)(1)(i) Infection Control Training and Education Infection control practices for hemodialysis units: intensive efforts must be made to educate new staff members and reeducate existing staff members regarding these practices. This Standard is not met as evidenced by: 32741 Based on document review, observation, and interview, it was determined that for 2 of 2 Patient Care Technicians (E #2 & E #4), the Facility failed to ensure that staff demonstrated knowledge of the Facility’s infection control practices for the disinfection of AVF (arteriovenous fistula - used for dialysis access) sites, as required. Findings include: 1. On 7/15/2024, the Facility’s policy titled, “Assessment and Cannulation for AV Fistula/Graft and Patient Self Cannulation” (dated 10/2023) was reviewed and indicated, “Cleansing Agent -Alcohol Prep Pad - cleaning process and contact time - utilizing a rubbing motion for at least 30 seconds.” 2. On 7/15/2024 at 10:00 AM, a Patient Care Technician (E #2) was preparing to access a fistula site for the initiation of dialysis at station #5. E #2 wiped the arterial access site with an alcohol pad for 13 seconds and venous access site for 15 seconds. Neither site was disinfected for 30 seconds. 3. On 7/15/2024 at 10:40 AM, a Patient Care Technician (E #4) was preparing to access a fistula site for the initiation of dialysis at Station #2. E #4 wiped the arterial access site with an alcohol pad for 2 seconds and venous site for 3 seconds. Neither site was disinfected for 30 seconds. 3. On 7/15/2024 at 11:05 AM, an interview was conducted with E#2. E #2 stated that each site should be disinfected for 30 seconds.”

“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: 50702 Based on document review, interview, and observation, it was determined that for 1 of 1 E#1, the facility failed to ensure that expired TB (Tuberculosis) medication had not been discarded as required. Findings include: 1. On 7/15/2024, the facility’s policy titled, “guidelines for administration of medication” (dated 04/2024) was reviewed and indicated, “Multi-dose vials will be discarded within 28 days of opening unless otherwise specified by manufacturer instructions. Unopened vials will be discarded according to the manufacturer’s expectation date..” 2. On 7/15/2024 from 8:45 am until 11:00 am, an observational tour was conducted in the in-center dialysis treatment center. The following was observed: -At 9:50 am 1 multi-dose vial of Tuberculin testing solution with open date for 5/6/2024 was found in the medication refrigerator. The vial should have been discarded on 6/6/2024. 3. On 7/15/2024 at 10:00 am, an interview was conducted with the clinic manager (E#1). E#1 stated that the vial should have been discarded.”

“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: 50702 Based on documents review, interview, and observation, it was determined that the 1 of 1 Registered Nurse (RN) (E#3) and 1 of 1 Patient Care Technician (PCT) (E#2), the facility failed to ensure that the staff demonstrate knowledge of the facility infection control practices of disinfection of Central Venous Catheter-use for dialysis access (CVC) initiation of dialysis catheter as required. Findings include: 1. On 7/15/2024, the facility policy titled, “Dialysis Catheter Dressing Change Procedure” (dated 2/2023) was reviewed and indicated “Cleaning Process and Contact Time, Use Gentle Back and Forth Strokes, Progressing from Catheter Exit Site Outward for 30-Seconds..” 2. On 7/15/2024 between 8:45am and 11:00am, an observational tour was conducted on in-center dialysis on the observation area, the following was observed. On 7/15/2024 at 10:25am, E #2 was observed cleaning the CVC site on a patient in the isolation room for 11 seconds (not the required 30 seconds). -On 7/15/2024 at 10:30am, E #3 on station #4 was observed cleaned the CVC site for 9 seconds (not the required for 30 second). 3. On 7/15/2024 at 11:05am, an interview was conducted on E#2. E#2 stated that CVC site should be cleaned for 30 seconds.”

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 32741 Based on document review and interview, it was determined that for 2 of 4 (Pt #2 and Pt #3) in-center hemodialysis clinical records reviewed for adherence to dialysis prescriptions, the Facility failed to monitor the BFR (Blood Flow Rate) and DFR (Dialysis Flow Rate) to ensure that the prescribed BFR and DFR were maintained for adequate hemodialysis. Findings include: 1. On 7/16/2024, the Facility’s policy titled, “Intradialytic Monitoring of Patient” (dated 9/2020) was reviewed and indicated, “Monitoring - Direct patient care staff will monitor the following parameters during each dialysis treatment - Blood flow rate and dialysate flow rate...” 2. On 7/16/2024, Pt #2’s in-center dialysis treatment records (dated 7/2/2024 thru 7/13/2024) were reviewed and indicated: -Pt #1’s hemodialysis prescription treatment order (dated 5/23/2024) noted “BFR 350 and DFR 700.” -Pt #1’s treatment records dated 7/9/2024 noted BFR 300 (not the prescribed BFR 350) and DFR 500 (not the prescribed 700). There was no documentation in Pt #1’s clinical record regarding the reason for not following the prescribed BFR and DFR. 3. On 7/16/2024, Pt #3’s in-center dialysis treatment records (dated 7/2/2024 thru 7/13/2024) were reviewed and indicated: -Pt #3’s hemodialysis prescription treatment order (dated 6/4/2024) noted “BFR 400 and DFR 700...” -Pt #3’s treatment records dated 7/11/2024 noted DFR 600 (not the prescribed DFR 700). There was no documentation in Pt #3’s record regarding the reason for not following the prescribed DFR. 4. On 7/16/2024 at 11:00 AM, an interview was conducted with the Clinical Area Manager (E #1). E #1 stated that each patient’s prescribed BFR and DFR should be followed.”