Fmc - New City

“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 3 Patient Care Technicians - PCT (E #4 and E #5) observed for disinfecting AVF (arteriovenous fistula) cannulation sites, the Facility failed to ensure that staff followed infection control practices to disinfect and prevent contamination of AVF sites, as required. Findings include: 1. On 11/13/2023, the Facility’s procedure titled, “Access Assessment and Cannulation” (dated 7/5/2022) was reviewed and required, “Skin disinfection - 70% isopropyl alcohol pad: Use gentle friction, clean the access site beginning in the center and continuing outward 2 inches in a concentric circle for 30 seconds and allow to dry before cannulation...” 2. An observational tour of the dialysis treatment area was conducted on 11/13/2023, between approximately 9:00 AM and 11:00 AM. The following was observed: - At approximately 9:50 AM, a PCT (E #5) was at station #13, preparing to initiate dialysis for a patient with an AVF. E#5 wiped the first access site with alcohol for a total of 15 seconds (not the required 30 seconds), then immediately inserted the catheter needle. E#5 then wiped the second access site with alcohol for a total of 10 seconds (not the required 30 seconds), then immediately inserted the catheter needle. -At approximately 10:00AM, a PCT (E#4) was at station #14, preparing to initiate dialysis for a patient with an AVF. E #4 wiped the first access site with alcohol for a total of 10 seconds (not the required 30 seconds), then immediately inserted the catheter needle. E #4 then wiped the second access site with alcohol for a total of 10 seconds (not the required 30 seconds), then immediately inserted the catheter needle. 3. On 11/13/2023 at 11:10 AM, E #5 stated that each site for AVF site should be disinfected for 30 seconds prior to cannulation.”

“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: 32741 Based on document review, observation and interview, it was determined that for 1 of 2 Patient Care Technicians - PCT ( E #3 ), the Facility failed to ensure that staff demonstrated knowledge of the Facility’s infection control practices for the disinfection of CVC (central venous catheter - used for dialysis access) insertion site for initiation of the dialysis treatment, as required. Findings include: 1. On 11/13/2023, the Facility’s policy titled, “Changing the Catheter Dressing Procedure” (dated 5/2/2022) was reviewed and required, “...Cleaning the Site - Follow the steps below to clean the catheter exit site - 70% alcohol -Use gentle friction, disinfect the access site beginning in the center and continuing outward 2 inches in a concentric circle for 30 seconds and allow to dry...” 2. On 11/13/2023 between 9:00 AM to 11:00 AM, an observational tour of the dialysis treatment area was conducted. At approximately 10:35 AM, a Patient Care Technician (E #3) was observed disinfecting a CVC site at station #6. E #3 disinfected the CVC site with 70 % alcohol for 40 seconds using a back and forth motion instead of disinfecting the access site beginning in the center and continuing outward in a concentric circle, as required. 3. On 11/13/2023 at 11:00 AM, an interview was conducted with E #3. E #3 stated that the CVC site should be disinfected for 1 minute using a circle motion.”