Davita Wallace Dialysis

“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 placed under the CVC limbs in one of two observation during a discontinuation using a CVC (PCT #1, Station #20) Findings included: Review on 04/16/2025 of the facility policy titled “Central Venous Catheter (CVC) with Clearguard HD Antimicrobial End Caps Procedure” revised October 2024 revealed “Upon Completion of Dialysis ... 28. Discard used barrier that was used during treatment and place a new clean, moisture proof barrier under catheter to prevent contamination. ...” Observation on 04/15/2025 at 1120 on the treatment floor revealed PCT #1 discontinued a hemodialysis treatment with Central Venous Catheter at Station #20 PCT #1 donned clean gloves, disconnected the extracorporeal lines from the CVC without placing a new clean moisture barrier pad under the CVC limbs. Observation revealed the facility policy was not followed. Interview on 04/15/2025 at 1130 with PCT #1 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. Interview on 04/16/2025 at 1400 with the Manager of Clinical Services revealed that the staff should place a clean moisture barrier pad underneath the catheter limbs to prevent contamination and anytime a barrier pad became soiled.”

“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 #6; PCT #2, Station #3; PCT #3). Findings included: Review on 04/16/2025 of the facility policy titled “AV (Arterio-venous) Fistula or Graft Cannulation ...” revised October 2022 revealed “ ... Skin Antiseptic: Povidone Iodine; Effective Volume: At least 1 prep pad per site or 1 saturated sterile gauze pad per site; Effective Contact Time: 30 seconds; Air Drying Time: 2 minutes ...” 1. Observation on 04/15/2025 at 1010 in the patient treatment area revealed PCT #2 entered Station #6 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #2 performed hand hygiene and applied clean gloves. PCT #2 cleansed the arterial and venous access sites with Povidone Iodine pad for less than 30 seconds at each site. PCT #2 allowed the access sites to dry for 2 minutes before cannulation. Observation revealed PCT #2 failed to disinfect each access site with Povidone Iodine for 30 seconds per the facility policy. Interview on 04/15/2025 at 1055 with PCT #2 revealed that each site should be disinfected for 30 seconds. Interview revealed that PCT #2 believed that she had disinfected the access sites for 30 seconds. Interview revealed PCT #2 failed to disinfect the access sites per facility policy. Interview on 04/16/2025 at 1400 with the Manager of Clinical Services revealed the staff were expected to disinfect each access site for 30 seconds when using Povidone Iodine pads and allow each site to dry for 2 minutes, prior to cannulating. Interview revealed the staff failed to follow the facility policy. 2. Observation on 04/15/2025 at 1100 in the patient treatment area revealed PCT #3 entered Station #3 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #3 performed hand hygiene and applied clean gloves. PCT #3 disinfected the arterial and venous access sites simultaneously with one Povidone Iodine pad for 30 seconds. PCT #3 allowed the access sites to dry for 2 minutes before cannulation. Observation revealed PCT #3 failed to disinfect each access site with Povidone Iodine for 30 seconds per the facility policy. Interview on 04/15/2025 at 1115 with PCT #3 revealed that the PCT failed to clean each access sites using two Povidone Iodine pads. Interview revealed that PCT #3 cleaned each site with alcohol pad prior to cleaning with the Povidone Iodine pad and thought it was okay to just use one Povidone Iodine pad since she had cleaned with alcohol pad. Interview revealed that PCT #3 did not follow the facility policy. Interview on 04/16/2025 at 1400 with the Manager of Clinical Services revealed the staff were expected to disinfect each access site for 30 seconds when using Povidone Iodine pads and allow each site to dry for 2 minutes, prior to cannulating. Interview revealed the staff failed to follow the facility policy.”