Davita Plainfield Renal Center

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 43294 Based on observation, record review, and interview, the facility failed to ensure all employees followed infection control guidelines for hand hygiene and gloving of 5 of 11 staff observed for infection control. (PCT 2, 3, 4, 6, Admin 3) Findings include: 1. A review of facility policy 1-05-01, “Infection Control for Dialysis Facilities,” last revised April 2023, indicated “ ... 1. All teammates, Physicians and Non-Physicians (NNP) will perform hand hygiene a. upon entering and exiting the patient treatment area, b. prior to gloving and immediately after removal of gloves, c. after contamination with blood or other infectious material, d. after patient and dialysis delivery system contact, e. after interacting with wall boxes (i.e. plugging/unplugging acid/bicarb lines form [sic] dialysis machine, changing acid types, when exchanging a dialysis machine), f. between patients even if the contact is casual, g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse. 2. Patients and caregivers will be encouraged to a. Wash their hands and access extremity upon entering the treatment area prior to the initiation of dialysis. b. Perform hand hygiene after treatment before leaving treatment area.” 2. On 04/01/24, at 10:35 AM, Patient Care Technician (PCT) 2 was observed assisting PCT 4 obtain access on Patient #1. PCT 4 requested assistance and stepped back to observe PCT 2 without doffing her gloves. PCT 2 asked PCT 4 for new syringes and PCT 4 was observed obtaining syringes from the center island drawer using her gloved hand and giving them to PCT 2. PCT 4 failed to remove contaminated gloves and complete hand hygiene after direct patient care and in advance of obtaining patient supplies. 3. On 04/01/24 at 10:48 AM, PCT 2 was observed at station 9 where she was wearing gloves and prepping the arm access for Patient #1. PCT 2 was observed leaving the patient’s chairside to obtain alcohol wipes from the island and returning to continue obtaining access on Patient #1. PCT 2 failed to remove contaminated gloves and complete hand hygiene after providing direct patient care and in advance of obtaining supplies. 4. On 04/01/24 at 10:50 AM, PCT 3 was observed cleaning and disinfecting an empty chair. When finished, PCT 3 removed and discarded her gloves and began entering data into the computer. After finishing data entry, PCT 3 completed hand hygiene, obtained clean gloves which she held in her hand, added more data via the computer keyboard, then donned the gloves. PCT 3 failed to complete hand hygiene after removing contaminated gloves, in advance of touching the computer keyboard, and in advance of donning clean gloves. 5. On 4/01/24 at 10:52 AM, PCT 3 left station 8, where she was setting up the station and entering data via the computer keyboard, donned a single glove and silenced the alarm at station 7 using the gloved hand, returned to station 8, donned a second glove, and continued to set up the station for the next patient. PCT 3 failed to remove contaminated gloves between patients/stations and failed to complete hand hygiene before donning clean gloves. 6. On 04/01/24 at 11 AM, PCT 3 indicated gloves should be changed between patients and patient care items, and hand hygiene should be done before donning clean gloves and after removing contaminated gloves. 7. On 04/01/24 at 12:02 PM, PCT 2 indicated gloves should be worn when touching a patient or the patient’s care supplies and should be changed between patients. Hand hygiene should be completed before and after all gloving. 8. On 04/01/24 at 1:36 PM, PCT 4 was observed cleaning and disinfecting the dialysis machine at station 9. When finished, PCT 4 removed and discarded her gloves and donned new gloves prior to answering an alarm. PCT 4 failed to complete hand hygiene after removing contaminated gloves and prior to donning clean gloves. 9. On 04/01/23 at 2:25 PM, PCT 2 was observed providing care to Patient #22 during discontinuation (DC) of dialysis. PCT 2 approached the chair of Patient #22, donned gloves, provided a glove for Patient #22, and discontinued the first access needle. After positioning Patient #22’s gloved hand to hold pressure, PCT 2 discontinued the second access needle and held pressure for several minutes. PCT 2 secured a dressing to the site, removed the patient’s glove and her gloves, and discarded them, then offered hand sanitizer to the patient upon exit. PCT 2 failed to complete hand hygiene after removing contaminated gloves. 10. On 04/01/24 at 2:35 PM, PCT 2 asked PCT 3 to obtain some gauze. PCT 3 was observed donning gloves and obtaining gauze from the center island, then passing the gauze to PCT 2. PCT 3 removed the gloves and discarded them. PCT 3 failed to complete hand hygiene prior to donning gloves and after doffing gloves. 11. On 04/01/24 at 3 PM, PCT 6 was observed setting up a dialysis machine. While cleaning the machine, PCT 6 removed her right glove, scratched her neck with her right hand, donned a clean right glove, silenced an alarm, and adjusted tubing on the machine, removed both gloves, and went to both islands to obtain supplies which she laid out on the chairside tray at station 6. PCT 6 opened a paper barrier and placed it under the supplies, returned to the island for more supplies, obtained 2 gloves which she donned then immediately removed, returned to the island for more supplies which she placed on the tray, and left the bedside. PCT 6 failed to complete hand hygiene prior to donning clean gloves, after doffing contaminated gloves, and prior to handling patient supplies. 12. On 04/01/24 at 3:46 PM, PCT 3 was observed cleaning and disinfecting a dialysis machine for Patient #22. PCT 3 approached the machine, donned gloves, and cleaned the machine using bleach-soaked gauze. When finished, PCT 4 removed and discarded her gloves. PCT 4 failed to complete hand hygiene prior to donning clean gloves and after removing contaminated gloves. 13. A review of the personnel file for PCT 2 evidenced infection control training was up to date and completed. 14. A review of the personnel file for PCT 3 evidenced infection control training was up to date and completed. 44232 15. During an observation on 04-01-2024 at 10:35 AM, PCT #2 discontinued the dialysis treatment for Patient #6. Patient #6 held pressure on their left lower vascular access site with a gloved right hand. Patient #6 discarded their glove in the trash receptacle beside their chair. PCT 2 obtained Patient #6’s weight before the patient left the treatment area. Patient #6 was not offered hand sanitizer or instructed to perform hand hygiene before leaving the treatment floor. During an interview on 04-01-2024 at 10:00 AM, PCT 5 confirmed hand hygiene was to be completed before applying gloves and after removing gloves. 16. During an observation on 04-01-2024 at 10:50 AM, Patient #7 was observed holding pressure to their left lower vascular access site with a right gloved hand. The Registered Nurse (RN) Manager, Admin 3, replaced the gauze pressure dressing, removed Patient #7’s glove, assisted Patient #6 to their wheelchair, and transported Patient #6 to the scale to obtain their weight. Admin 3 failed to remove their gloves, perform hand hygiene, and apply new gloves after removing Patient #6’s glove. Patient #6 was not provided hand sanitizer or instructed to perform hand hygiene before leaving the treatment area. 17. A review of an agency document titled “Star Learning” indicated that Admin 3 successfully completed DaVita’s infection control program on 01-07-2023. 18. During an observation on 04-01-2024 at 2:45 PM, PCT 6 was observed at Station #10, discontinuing the dialysis treatment for Patient #4. The PCT applied a gauze dressing to the ports of the Central Venous Catheter (CVC) (a vessel inserted into a vein below the collar bone). PCT 6 removed their gloves, discarded them in the trash receptacle, and did not perform hand hygiene before applying new gloves. 19. A review of agency documents titled “Infection Control Audits” dated 01-10, 01-12, 01-15, 01-17, 01-19, and 01-22-2024 indicated the agency staff and patients were not performing hand hygiene prior to and after gloves were removed. During an interview on 04-02-2024 at 3:30 PM, when queried about the completion of infection control audits, the Facility Administrator (FA) indicated that no infection control audits were completed for February or March 2024.”

“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: 44232 Based on observation, record review, and interview, the facility failed to ensure cross-contamination of supplies in 1 of 3 observations. Findings Include: 1. A review of a DaVita Incorporated policy with a revision date of April 2018, titled “Physical Environment,” indicated but was not limited to, “ ... the building in which dialysis services are furnished will be constructed and maintained for safety of the patients, the teammates and the public ... provide needed care and services prevent cross contamination ... “ 2. On 04-01-2024 at 8:40 AM, observed during the flash tour a dialyzer, connection tubing, a bag of 0.9% sodium chloride (intravenous fluid used to supply the body with water and salt), a purple top specimen tube, a barrier bundle with dialysis set-up supplies, and a labeled 5 milliliter (ml) syringe filled with heparin (a medication used to prevent blood clotting) 2,000 units for Patient #1 on the surround wall unit shelf behind Station #10. 3. On 04-01-2024 at 8:50 AM, observed during the flash tour a dialyzer, connection tubing, a bag of 0.9% sodium chloride, a barrier bundle with dialysis set-up supplies, and a labeled 5 ml syringe filled with heparin 1,000 units for Patient #25 on the surround wall unit shelf behind Station #12. 4. . On 04-01-2024 at 8:54 AM, observed during the flash tour a dialyzer, connection tubing, a bag of 0.9% sodium chloride, a purple top specimen tube, a barrier bundle with dialysis set-up supplies, and 2 labeled 5 ml syringe filled with heparin 1,900 units for Patient #8 on the dialysis treatment chair of Station #11. 5. A review of an agency document titled, “Star Learning” indicated PCT 4 successfully completed DaVita’s health and safety training on 05-05-2023. During an interview on 04-01-2024 at 9:04 AM, when queried regarding the supplies of Patients being on the wall unit shelf and chair while patients were being treated in those chairs, the Patient Care Technician (PCT) 4 indicated PCT 2 had told them they could not store next patient supplies on the wall units.”

“IC-HANDLING INFECTIOUS WASTE CFR(s): 494.30(a)(4)(i) [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- (i) Handling, storage and disposal of potentially infectious waste; This Standard is not met as evidenced by: 43294 Based on observation, record review, and interview the facility failed to ensure employees followed infection control precautions during disposal of blood for 1 of 1 Patient Care Technician (PCT) observed discarding blood. (PCT 1) Findings include: 1. A review of facility policy 4-03-05, “Biohazardous Cleanup,” last revised April 2018, evidenced guidance on biohazardous cleanup related to medical waste spills. The policy failed to evidence guidance related to disposal of blood-contaminated items other than spills. 2. A review of facility policy 4-03-01, “Medical Waste Management Plan,” last revised October 2023, indicated the purpose of the plan was “To provide guidance on the handling, storage, treatment and disposal of medical waste and remain in compliance with state environmental and health departments ... Medical waste is healthcare waste that may be contaminated by blood ... it includes ... effluent bags. The “Medical Waste Management Plan” failed to evidence guidance for the management and disposal of effluent bags contaminated with blood. 3. On 04/01/24 at 2:36 PM, PCT 1 was observed carrying an intravenous (IV) bag contaminated with blood to the island sink. PCT 1 emptied the bag into the sink and followed it with an unknown amount of bleach. PCT 1 indicated the previous patient from station 11 had the wrong line hooked up with the rinse causing blood to rinse back into the bag of saline. When asked concerning the process for disposing of blood and blood products, PCT 1 indicated protocol was to clean blood spills with bleach so she followed with bleach after emptying the bag. 4. On 04/01/24 at 3:58 PM, the Administrator indicated the contaminated IV bag should have been discarded in the biohazard bin and not discarded down the sink.”

“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: 43294 Based on observation, record review, and interview the agency failed to ensure expired medications and supplies were discarded, for 1 of 1 flash tour of an ESRD facility. Findings include: 1. A review of policy 1-06-01, “Medication Policy,” last revised October 2023, indicated “ ... 13. ... Do not use any medication that has been stored improperly or has expired ... 30. All medications in the facility are checked monthly for expiration dates. 2. On 04/01/24 at 8:30 AM, a flash tour was conducted and evidenced an open vial of Heparin 30,000 units/30 milliliters (ml) in the cabinet located in training room #1 which was marked as opened on 02/22/24. Further review evidenced 5 gold topped lab tubes with expiration dates of 03/31/24 and a box of sterile 10 ml syringes with idnividual expiration dates of 08/22/22. 3. On 04/01/24 at 3:58 PM, the Administrator indicated an opened vial of heparin should be discarded after 30 days and the tubes and syringes should also have been discarded on or before their expiration dates.”

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 44232 Based on observation, record review, and interview, the facility failed to provide a safe and comfortable environment for 1 of 1 stand alone in-center dialysis facilities. Findings Include: 1. A review of a DaVita Incorporated policy with a revision date of April 2018, titled “Physical Environment,” indicated but was not limited to, “ ... the building in which dialysis services are furnished will be constructed and maintained for safety of the patients, the teammates and the public ... Supplies will not be stored directly on the floor but on shelves or pallets ... “ 2. On 04-01-2024 at 9:12 AM, during a flash tour of the water room, observed a pile of dirt debris, salt pellets, and broken pieces of wood pallets in front of the black trash receptacle in the entryway on the floor on the left side of the entrance door. 3. On 04-02-2024 at 3:15 PM, observed a pile of dirt debris, salt pellets, and broken pieces of wood pallets in front of the black trash receptacle in the entryway on the floor on the left side of the entrance door. 4. On 04-03-2024 at 10:45 AM, observed a pile of dirt debris, salt pellets, and broken pieces of wood pallets in front of the black trash receptacle in the entryway on the floor on the left side of the entrance door. During an interview on 04-03-2024 at 11:05 AM, the Registered Nurse (RN) Manager, Admin 3, confirmed they saw debris on the floor of the water room. Admin 3 further indicated there was no excuse for the staff not to pick up and clean the water room.”

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 44232 Based on observation, record review, and interview, the facility failed to ensure the staff used Personal Protective Equipment (PPE) and hand hygiene appropriately while on the treatment floor by 3 of 4 Patient Care Technicians. (Patients: #8, 9, 10, and 13 ) (Employees: Patient Care Technician (PCT) 1 (twice), 2, and 3) Findings Include: 1. An agency policy titled “Infection Control For Dialysis Facilities,” 1-05-01 indicated but was not limited to, “ ... Hand Hygiene ... 1. All teammates, Physicians and Non-Physicians will perform hand hygiene ... a. prior to gloving and immediately after removal of gloves ... d. after patient and dialysis delivery system contact ... f. between patients even if the contact is casual, g. before touching clean areas such as supplies, supply cart, and chairside keyboard/mouse ... 2. Patients and caregivers will be encouraged to ... b. Perform hand hygiene after treatment before leaving treatment area ... PPE ... a. Gloves should be changed when ... ii. When going from a “dirty” area or task to a “clean” area or task ...” 2. On 12-27-2023 at 3:10 PM, signs were posted on the wall above the sink, and the Entrance door of the treatment area was reviewed. Both signs stated, “For your protection, please wash your hands upon entering and exiting the unit. If you are unable, there is sanitizer available for you at the scale.” 3. During an observation on 12-27-2023 at 11:20 AM, PCT 3 was observed at Station #10, to locate/palpate Patient #8’s Arteriovenous (AV) Fistula (an abnormal connection between than artery and a vein) cannulation sites with a red stethoscope before initiation of dialysis. PCT 3 placed the bell of the red stethoscope on Patient #8’s upper left access site, removed the stethoscope, and placed the stethoscope on the center island workstation. PCT 3 then was observed at Station #10, with Patient #8 applying antiseptic over the skin of the cannulation sites. PCT 3 failed to discard their gloves, perform hand hygiene, and don new gloves before applying antiseptic to the skin over the cannulation sites. 4. During an observation of exit site care on 12-27-2023 at 11:30 AM, PCT 2 removed the old dressing from Patient #13’s Central Venous Catheter (CVC) (a catheter inserted into a major vein). PCT 2, removed the old dressing from Patient #13, discarded the dressing in the trash, and cleansed the area around the CVC exit site. PCT 2 failed to remove their gloves, perform hand hygiene, and don new gloves after discarding the old dressing and before cleansing the CVC exit site. During an interview on 12-27-2023 at 11:40 AM, when queried regarding infection control practices when changing a CVC dressing, confirmed after removing the old dressing they are to discard gloves, perform hand hygiene, and don new gloves. 5. During an observation of post dialysis access care for an AV fistula on 12-27-2023 at 3:15 PM, Patient #10 was observed holding gauze over their left access site with a gloved right hand. PCT 1 applied a new dressing to the patient’s access, and Patient #10 was observed discarding their glove in the trash receptacle beside their chair. Patient #10 left Station #17 with PCT 1 to the scale, obtained their weight, and left the treatment floor. Patient #10 was not offered hand sanitizer or instructed to perform hand hygiene before leaving the treatment floor. 6. During an observation of post dialysis access care for an AV fistula on 12-27-2023 at 3:25 PM, Patient #9 was observed holding gauze over their left access site with a gloved right hand. PCT 1 applied a new dressing to the patient’s access, and Patient #9 was observed discarding their glove in the trash receptacle beside their chair. Patient #9 left Station #18 with PCT 1 to the scale, obtained their weight, and left the treatment floor. Patient #9 was not offered hand sanitizer or instructed to perform hand hygiene before leaving the treatment floor. 7. During an interview on 12-27-2023 at 4:45 PM, the Facility Administrator, Admin 1, confirmed after staff removed the old CVC exit site dressing, they should have discarded their gloves, performed hand hygiene, and donned new gloves before cleansing the exit site. 8. During an interview on 12-28-2023 at 11:30 AM, Admin 1 and the Facility Administrator in training, Admin 2, confirmed hand hygiene should be offered or instructed to the patients after they held the pressure dressing on their access.”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 44232 Based on observation and interview, the agency failed to ensure all items taken to the dialysis station were disposed of after use, cleaned and disinfected, and stored without risk of exposure to containments in 1 of 1 stand alone in-center dialysis treatment centers. Findings Include: 1. A revised April 2023 agency policy titled “Infection Control For Dialysis Facilities,” 1-05-01 indicated but was not limited to, “ ... 10. Unused supplies ( ... tape ...) ... taken into the station should be used only for that patient and should not be returned to a common clean area or used on other patients ...” 2. During an observation on 12-27-2023 at 2:40 PM, observed at Station #7, Patient #15 receiving dialysis treatment. Noted a roll of white tape adhered to the right armrest of Patient #15’s treatment chair. 3. During an observation on 12-27-2023 at 2:45 PM, observed at Station #8, Patient #16 receiving dialysis treatment. Noted a roll of white tape adhered to the left treatment tray’s posterior ledge of Patient #16’s treatment chair. 4. During an observation on 12-27-2023 at 2:50 PM, observed behind Station #7 and #8 on the surround wall unit shelf, 1 blue surgical mask, 1 box of small gloves, 1 Kleenex box, a black hose, and a blood pressure cuff. 5. During an observation on 12-27-2023 at 3:10 PM, observed at Station #4, a roll of white tape adhered hanging down the front of the dialysate machine. 6. During an observation on 12-27-2023 at 3:15 PM, observed at Station #3, a white roll of tape adhered to the treatment chair’s left treatment tray. 7. During an observation on 12-27-2023 at 3:16 PM, observed a roll of white tape adhered to the countertop’s ledge in front of the clean sink. During an interview on 12-27-2023 at 4:00 PM, PCT 1, confirmed tape should not be adhered to the trays of the treatment chairs or dialysate machines. 8. During an interview on 12-27-2023 at 4:40 PM, the Facility Administrator (FA), Admin 1 confirmed tape should not be hanging off the treatment chairs, the treatment chair’s treatment trays, and the dialysate machines. Admin 1 further stated, “That was old school.””