Dci - Tulane-New Orleans

“IC-SANITARY ENVIRONMENT CFR(s): 494.30 The dialysis facility must provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit and any adjacent hospital or other public areas. This Standard is not met as evidenced by: 14442 Based on observation and interview, the dialysis facility failed to monitor a sanitary environment to minimize the transmission of infectious agents by failing to ensure patients perform hand hygiene after each dialysis treatment for 3 (#1, R1, R2) of 3 patients observed. This deficient infection control practice presented a risk for cross-contamination and infection to the 46 in-center hemodialysis patients on census. Findings: Observation of the in-center hemodialysis treatment room on 06/27/2024 from 9:40 a.m. to 11:10 a.m. revealed Patient #1, Patient R1, and Patient R2 had on disposable gloves and were applying pressure to stop bleeding from vascular access needle sites post dialysis treatment. Further observation revealed Patient #1, Patient R1, and Patient R2 removed contaminated disposable gloves and did not perform hand hygiene before leaving the treatment room. In an interview on 07/01/2024 at 9:12 a.m., S2Nurse Manager confirmed patients should perform hand hygiene after removing gloves and before leaving the treatment area.”

“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: 14442 Based on observation and interview, the dialysis facility failed to demonstrate that it followed standard infection control precautions for cleaning and disinfection of contaminated equipment. This deficient practice was evidenced by failing to ensure that all surfaces of patient dialysis treatment chairs were thoroughly cleaned and disinfected for 2 (#1, #24) of 2 patient treatment stations inspected. Findings: 1. Observation on 06/27/2024 at 1:20 p.m. of hemodialysis treatment station #1 revealed the chair prepped with clean supplies and ready for the next patient. Further observation revealed bright red blood near the right side of the seat cushion. In an interview on 06/27/2024 at 1:22 p.m., S2Nurse Manager confirmed presence of blood on the patient treatment chair. S2Nurse Manager confirmed the patient treatment chair was not thoroughly cleaned and disinfected. 2. Observation on 06/27/2024 at 1:44 p.m. of hemodialysis treatment station #24 revealed the chair prepped with clean supplies and ready for the next patient. Further observation revealed dried blood and a blue tourniquet near the right side of the seat cushion. In an interview on 06/27/2024 at 1:48 p.m., S2Nurse Manager confirmed presence of blood and tourniquet on the patient treatment chair. S2Nurse Manager confirmed the patient treatment chair was not thoroughly cleaned and disinfected.”

“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: 14442 Based on observation and interview, the dialysis facility failed to be maintained to provide patients a safe treatment environment. This deficient practice was evidenced by having water on the floor by patient treatment stations #1, #2, #18, and #23. Findings: 1. Observation on 06/27/2024 at 10:58 a.m. revealed water on the floor by station #18 hemodialysis machine and treatment chair. In an interview on 06/27/2024 at 11:01 a.m., S4CCHT confirmed water on the floor by station #18. S4CCHT confirmed that she was not aware of the water on the floor. 2. Observation on 06/27/2024 at 1:26 p.m. revealed water on the floor by station #1 and station #2 hemodialysis machine and treatment chair. 3. Observation on 06/27/2024 at 2:06 p.m. revealed water leaking from the front of station #23 hemodialysis machine and onto the floor. In an interview on 06/27/2024 at 2:14 p.m., S3Chief Technician confirmed water on the floor by treatment stations #1, #2, and #23. S3Chief Technician confirmed that he was not aware of water on the floor by treatment stations #1, #2, and #23.”

“PE-HD PTS IN VIEW DURING TREATMENTS CFR(s): 494.60(c)(4) Patients must be in view of staff during hemodialysis treatment to ensure patient safety, (video surveillance will not meet this requirement). This Standard is not met as evidenced by: 14442 Based on observation and interview, the dialysis facility failed to ensure each patient’s (R3, R4) face and vascular access sites and bloodline connections were visible throughout the dialysis treatment. This deficient practice presented a risk for undiscovered accidental needle dislodgement or a line disconnection to go undetected with resultant hemorrhage to the 46 in-center hemodialysis patients on census. Findings: Observation of the in-center hemodialysis treatment room on 06/27/2024 from 9:40 a.m. to 10:35 a.m. revealed Patient R3 and Patient R4 receiving hemodialysis treatments with their face and vascular access sites and bloodline connections completely covered by a blanket. In an interview on 07/01/2024 at 9:16 a.m., S2Nurse Manager confirmed each patient’s face and vascular access site and bloodline connections should remain uncovered and visible throughout the dialysis treatment.”