Fmc Bma of Pamlico

“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: 26622 Based on facility policy review, observations, and staff interviews, the facility staff failed to prevent potential cross contamination by failing to ensure a clean field was under the CVC limbs in one of two observation during a discontinuation using a CVC (PCT #3, Station #17) Findings included: Review on 03/21/2025 of the facility policy titled “Termination of Treatment Using a Central Venous Catheter and Optiflux Single Use Ebeam Dialyzer,” published 11/04/2024 revealed “... Prior to Termination: Preparation ... Step 5. Ensure that a clean underpad is below the catheter limbs to protect the work area and the clothing. ... Termination: Disinfection of of Catheter and Disconnecting the Patient ... Step 6 ...NOTE: Do not place uncapped catheter limbs on underpad to prevent contamination. 7. Hold the limb while allowing the antiseptic to dry. ...” Observation on 03/19/2025 at 1524 on the treatment floor revealed PCT #3 discontinued a hemodialysis treatment with Central Venous Catheter at Station #17. PCT #3 donned clean gloves, disconnected the extracorporeal lines from the CVC , without placing a new clean under pad under the CVC limbs. Observation revealed the facility policy was not followed. Interview on 03/19/2025 at 1530 with PCT #3 revealed that the PCT usually places a clean underpad under the catheter limbs but admitted that she did not place the clean pad under the catheter limbs during the observation. The facility staff failed to follow the facility policy for discontinuing a Central Venous Catheter.”

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 26622 Based on policy and procedure review, observations, and staff interviews, the facility failed to ensure staff performed skin antisepsis per policy before cannulation of 2 of 2 Arterio-venous fistula/graft (AVF/AVG) cannulation procedures observed (Station #19, PCT #2; Station #1, PCT #1). Findings include: Review on 03/21/2025 of the facility policy “Access Assessment and Cannulation,” Published: 05/06/2024, revealed “... Assessment of Vascular Access ... Skin Disinfection Step 1 Disinfect cannulation site as follows using any of the disinfectants below: 70% isopropyl alcohol pad: Using 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. ...” 1. Observation on 03/19/2025 at 1145 in the patient treatment area, revealed PCT #2 entered Station #19 and prepared to access the patient’s AVF/AVG. Observation revealed PCT #2 donned clean gloves and applied antiseptic (70% isopropyl alcohol pad) to each access site over the skin in a concentric circle for 5 seconds. The observation revealed the PCT failed to clean each access site for 30 seconds per facility policy. Interview on 03/19/2025 at 1150 with PCT #2 revealed that PCT #2 verbalized the appropriate cleaning time for the cannulation of access sites. Interview revealed PCT #2 did not use the second hand on the available treatment floor clocks. Interview revealed PCT #2 failed to clean/disinfect each of the access sites for 30 seconds, prior to cannulation and securing the needles. Interview revealed PCT #2 failed to follow the facility policy. Interview on 03/21/2025 at 1600 with the Charge Nurse and Operations Director revealed the staff were expected to disinfect each access site for 30 seconds when using alcohol pads. Interview revealed the PCT did not follow the facility policy. 2. Observation on 03/21/2025 at 1045 in the patient treatment area, revealed PCT #1 entered Station #1 and prepared to access the patient’s AVF/AVG. Observation revealed PCT #1 donned clean gloves and applied antiseptic (70% isopropyl alcohol pad) to each access site over the skin in a concentric circle for less than 10 seconds. Observation revealed PCT #1 failed to clean each access site for 30 seconds per facility policy. Interview on 03/19/2025 at 1100 with PCT #1 revealed that PCT #1 verbalized the appropriate cleaning time for the cannulation of access sites. Interview revealed PCT #1 did not use the second hand on the available treatment floor clocks. Interview revealed PCT #1 failed to clean/disinfect each of the access sites for 30 seconds, prior to cannulation and securing the needles. Interview revealed PCT #1 failed to follow the facility policy. Interview on 03/21/2025 at 1600 with the Charge Nurse and Operations Director revealed the staff were expected to disinfect each access site for 30 seconds when using alcohol pads. Interview revealed the PCT did not follow the facility policy.”