Davita Hendersonville Dialysis Center

“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: 35306 Based on facility policy review, observation and staff interview, the facility staff failed to prevent potential cross-contamination in 2 of 2 Central Venous Catheter (CVC) exit site care observations (PCT #1, Station #1, Patient #11 and PCT #2, Station #9, Patient #12). Findings included: Review on 03/20/2024 of the facility’s policy titled, “CENTRAL VENOUS CATHETER (CVC) WITH CLEARGUARD HD ANTIMICROBIAL END CAPS PROCEDURE”, Revision Date: October 2023 revealed, “... 8....clean exit site with 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab for a minimum of 30 seconds, apply to the CVC exit site in a “back and forth” pattern, using gently friction progressing from the insertion site to the periphery using both sides of the swab. If site is not free of exudates, repeat this step with a new 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab...” 1. Observation on 03/20/2024 at 1055 revealed Patient #11 had a CVC access and was assigned to Station #1 for ICHD. Observation revealed that PCT #1 cleansed the area around the CVC exit site with a 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab, progressing from the insertion site to the periphery and returned to the CVC insertion site and swabbed the area again, using the same 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab previously used. Interview on 03/21/2024 at 1230 with PCT #1 revealed, “I start in the center at the insertion site and work from the middle out.” Interview revealed that PCT #1 did not realize that he had returned to the CVC insertion site after cleansing the area durng the observation. Interview revealed, “I should not have gone back to the insertion site using the same swab.” Interview on 03/21/2024 at 1345 with the facility FA revealed the staff were expected to follow the steps outlined in the facility’s procedure for CVC exit site care to prevent potential cross-contamination. 2. Observation on 03/20/2024 at 1113 revealed Patient #12 had a CVC access and was assigned to Station #9 for ICHD. Observation revealed that PCT #2 cleansed the area around the CVC exit site with a 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab, progressing from the insertion site to the periphery and returned to the exit site using the same swab. Interview on 03/20/2024 at 1130 with PCT #2 revealed the exit site should be cleansed from the insertion site to the periphery, without returning to the insertion site, unless a new 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab is used. Interview revealed PCT #2 did not realize that she had retruned to the CVC insertion site after cleansing the area during the observation. Interview revealed, “I should not have done that.” Interview on 03/21/2024 at 1345 with the facility FA revealed the staff were expected to follow the steps outlined in the facility’s procedure for CVC exit site care to prevent potential cross-contamination.”

“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: 35306 Based on facility policy review, observation, and staff interview, the facility’s staff failed to prevent cross-contamination of a patient vascular access cannulation site by touching the site after applying antiseptic to skin and immediately inserting the cannulation needle in 1 of 2 observed vascular access site cannulation insertions (PCT #2, Station #6, Patient #15). Findings included: Review on 03/31/2024 of the facility’s policy titled, “AV FISTULA OR GRAFT CANNULATION WITH NIPRO OR MEDISYSTEMS SAFETY FISTULA NEEDLES (SFN) AND ADMINISTRATION OF HEPARIN LOADING DOSE” Revision Date: October 2022 revealed, “Preparation of sites for needle placement: 1. Use an approved antiseptic to clean the insertion site following,”... 11. While maintaining aseptic technique, cleanse the site by applying skin antiseptic using a circular rubbing motion, moving from the center out... 13. Do not palpate insertion site once area has been prepped... Once the access site has been prepped, touching it will contaminate the site and possibly allow for the introduction of bacteria during cannulation...” Observation on 03/20/2024 at 1143 revealed patient care technician (PCT) #2 initiating the access of Patient #15’s left arm vascular access site at Station #6. The observation revealed the PCT applied the facility’s cannulation site disinfectant to both the patient’s cannulation insertion sites, arterial and venous. Observation further revealed that after the PCT applied the antiseptic over the cannulation sites, the PCT touched the second (venous) site again with a gloved hand. Observation further revealed that without again applying antiseptic to the site, she inserted the needle into the insertion site potentially cross contaminating the patient’s left arm vascular access site. Interview on 03/20/2024 at 1210 with PCT #2 revealed that the PCT did not realize that the insertion site had been touched after it had been prepped. Interview revealed PCT #2 indicated insertion sites should not be touched again after being prepped to prevent potential cross-contamination or infection of the access site. Interview on 03/21/2024 at 1345 with the facility’s clinical manager revealed that the PCT should not have touched the insertion sites once the areas had been prepped.”