Davita Maysville Dialysis

“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: 50873 Based on observation, interview, and facility policy review, the facility failed to ensure hand hygiene was performed by 3 of 5 staff members observed providing patient care, Patient Care Technician (PCT) 5, PCT8, and the Administrator. The findings include: Review of the facility’s policy titled, “Infection Control for Dialysis Facilities,” revised April 2023, stated, “Hand Hygiene 1. All teammates, Physicians and Non-Physician (NPP) 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. [id est, that is], plugging/unplugging acid/bicarb [bicarbonate] lines from dialysis machine, changing acid types, when exchanging a dialysis machine), f. between patients even if the contact is casual, [and] g. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse.” Review of the facility’s policy titled, “Central Venous Catheter [CVC] with [Name of Brand] HD [hemodialysis] Antimicrobial End Caps Procedure,” revised 10/2024, revealed the table labeled, ‘Procedure,’ [indicated] 4. Remove old [CVC] dressing and discard, [and] 7. Remove gloves and discard. Perform hand hygiene per procedure and re-glove.” 1. Observation on 01/22/2025 at 11:35 AM revealed PCT8 brought a bottle of pH strips (test strips used to measure the acidity or alkalinity of a substance) into dialysis Patient Treatment Station 5, touched the dialysis machine, took out a pH test strip, left the patient treatment station, and returned the bottle to the clean supply cart. PCT8 collected a dialysate (fluid used in the dialysis machine to remove impurities) sample in a sample cup, tested the pH of the dialysate using a pH test strip, left the patient treatment station, placed the used sample cup on the clean supply cart, returned to Patient Treatment Station 5, and resumed setup of the dialysis machine. During this time, PCT8 was observed wearing the same pair of gloves until leaving the dialysis patient treatment station at 11:38 AM. PCT8 failed to change gloves and perform hand hygiene upon leaving and entering the patient treatment station to access the clean supply cart, and this had the potential to contaminate the clean supplies. 2. Observation on 01/22/2025 at 11:57 AM revealed PCT5 entered Patient Treatment Station 3 wearing a stethoscope around her neck. PCT5 donned gloves and touched the dialysis machine to turn off an alarm. PCT5 left Patient Treatment Station 3, put the stethoscope on the clean supply cart, and returned to the patient treatment station. PCT5 failed to perform hand hygiene when entering and leaving the patient treatment station to access the clean supply cart. 3. Observation on 01/22/2025 at 12:20 PM revealed PCT8 assessed a patient’s dialysis access in Patient Treatment Station 11. PCT8 left Patient Treatment Station 11, placed the stethoscope on the nurse’s station, returned to Patient Treatment Station 11, and applied antiseptic to the patient’s access. PCT8 failed to perform hand hygiene and change gloves when leaving and reentering the patient treatment station. 4. Observation on 01/22/2025 at 12:26 PM revealed PCT5 cannulated (inserted a needle into a vein to allow a patient’s blood to circulate through the dialysis machine) a patient in dialysis Patient Treatment Station 10. PCT5 was wearing a stethoscope and gloves. PCT5 left the patient treatment station, placed the stethoscope on the clean cart, removed her gloves, and performed hand hygiene. PCT5 failed to perform hand hygiene when leaving the dialysis patient treatment station and prior to accessing the clean supply cart. 5. Observation on 01/23/2025 at 11:43 AM revealed PCT8 performed CVC site care at dialysis Patient Treatment Station 5. PCT8 removed the dirty CVC dressing and then proceeded to clean the exit site. PCT8 failed to perform hand hygiene and change gloves after removing the dirty CVC dressing. 6. Observation on 01/23/2025 at 11:46 AM revealed the Administrator performed CVC site care at dialysis Patient Treatment Station 7. The Administrator removed the dirty CVC dressing and then proceeded to clean the exit site. The Administrator failed to perform hand hygiene and change gloves after removing the dirty CVC dressing. In an interview on 01/24/2025 at 9:57 AM, PCT8 stated hand hygiene should be performed and gloves should be changed after removing a dirty CVC dressing, when entering and leaving the patient treatment stations, when touching the dialysis machine, and after touching a patient. In an interview on 01/24/2025 at 9:10 AM, Registered Nurse (RN) 1 stated hand hygiene and glove changes should occur when entering and leaving the patient treatment station, after touching the dialysis machine, and after removing a dirty CVC dressing and prior to cleaning the CVC exit site. In an interview on 01/23/2025 at 4:25 PM, the Medical Director stated hand hygiene and glove changes should be performed on entering and leaving the patient treatment area and after removal of a dirty CVC dressing.”

“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: 50873 Based on observation, interview, and facility policy review, the facility failed to ensure reusable items were disinfected when removing them from the dialysis patient treatment stations by 2 of 5 staff members observed providing patient care, Patient Care Technician (PCT) 5 and PCT8. The findings include: Review of the facility’s policy titled, “Infection Control for Dialysis Facilities,” revised April 2023, stated, “Cleaning and/or disinfection of equipment and work surfaces will be performed as soon as possible following exposure to blood or other potentially infectious materials [i.e. id est, that is] used or brought into the station and prior to returning to clean/designated area or removal from treatment area.” 1. Observation on 01/22/2025 at 11:35 AM revealed PCT8 brought pH strips (test strips used to measure the acidity or alkalinity of a substance) into dialysis Patient Treatment Station 5, touched the dialysis machine, took a pH test strip out of its bottle, left the patient treatment station, and returned the bottle to the clean supply cart. PCT8 collected a dialysate (fluid used in the dialysis machine to remove impurities) sample in a sample cup, tested the pH of the dialysate using the pH test strip, left the patient treatment station, placed the used sample cup on the clean supply cart, returned to Patient Treatment Station 5, and resumed setup of the dialysis machine. During this time, PCT8 was observed wearing the same pair of gloves until leaving the station at 11:38 AM. PCT8 failed to disinfect the pH strip bottle upon leaving the patient treatment station and prior to returning it to the clean supply cart. 2. Observation on 01/22/2025 at 11:57 AM revealed PCT5 entered Patient Treatment Station 3 wearing a stethoscope around her neck. PCT5 donned gloves and touched the dialysis machine to turn off an alarm. PCT5 left Patient Treatment Station 3, put the stethoscope on the clean supply cart, and returned to the patient treatment station. PCT5 failed to disinfect the stethoscope when it was removed from the patient treatment station and prior to placing it on the clean supply cart. 3. Observation on 01/22/2025 at 12:20 PM revealed PCT8 assessed a patient’s dialysis access in Patient Treatment Station 11. PCT8 left Patient Treatment Station 11, placed the stethoscope on the nurse’s station, returned to Patient Treatment Station 11, and applied antiseptic to the patient’s access. PCT8 failed to disinfect the stethoscope when it was removed from the patient treatment station and prior to placing it in a clean area, the nurse’s station. 4. Observation on 01/22/2025 at 12:26 PM revealed PCT5 cannulated (inserted a needle into a vein to allow a patient’s blood to circulate through the dialysis machine) a patient in dialysis Patient Treatment Station 10. PCT5 was wearing a stethoscope and gloves. PCT5 left the patient treatment station, placed the stethoscope on the clean cart, removed her gloves, and performed hand hygiene. PCT5 failed to disinfect the stethoscope prior to placing it on the clean supply cart. 5. Observation on 01/23/2025 at 11:38 AM revealed PCT8 picked up a non-contact thermometer from the clean chairside computer station while wearing gloves, brought the thermometer into dialysis Patient Treatment Station 5, took a patient’s temperature, and then returned the thermometer to the chairside computer station. PCT8 failed to disinfect the thermometer when taking it out of the patient treatment station and placing it in a clean area. In an interview on 01/24/2025 at 9:57 AM, PCT8 stated that items removed from the patient treatment area, such as thermometers, should be disinfected, and the computer area was outside of the patient treatment area. In a follow-up interview on 01/24/2025 at 10:55 AM, PCT8 confirmed she had not disinfected the thermometer prior to removing it from the patient treatment area and stated the reason was “because I was nervous.” In an interview on 01/24/2025 at 9:10 AM, Registered Nurse (RN) 1 stated reusable items brought into the patient treatment station, including temporal thermometers, should be disinfected upon removal from the station. RN1 stated the chairside computer area was considered a clean area. In an interview on 01/23/2025 at 4:25 PM, the Medical Director stated items removed from the patient treatment station should be disinfected.”