Davita Cape Fear 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 policy review, observation and interview, the patient care staff failed to disinfect the Central Venous Catheter (CVC) hubs per facility policy for 1 of 2 observed initiation of hemodialysis treatment with a CVC (PCT #2, Station #8) and failed to disinfect a CVC exit site with 2 % Chlorhexidine Gluconate/70 % Isopropyl alcohol and allow to dry for 60 seconds per facility policy for 1 of 2 observed CVC exit sites disinfected with Chlorhexidine (PCT #2, Station #8). Findings include: 1. Review on 12/09/2024 of the facility policy/procedure titled “Central Venous Catheter (CVC) With Clearguard HD Antimicrobial End Caps Procedure” effective October 2024 revealed “ ... 16. Verify both catheter clamps are closed. Using aseptic technique, remove each cap. One at a time, disinfect each CVC hub with a new alcohol prep pad. Scrub each CVC hub for 15 seconds including the sides, threads and end of hub thoroughly with friction making sure to remove any residue, for example blood. Hold the limbs until the antiseptic has dried.” Observation on 12/09/2024 at 1320 in the patient treatment area revealed PCT #2 entered Station #8 and initiated access of a Central Venous Catheter (CVC). Observation revealed PCT #2 performed hand hygiene, applied clean gloves. Observation revealed PCT #2 cleansed the arterial catheter hub and the venous catheter hubs for 10 seconds each. The observation revealed that PCT #2 failed to cleanse each catheter hub for 15 seconds per facility policy. Interview on 12/09/2024 at 1356 with PCT #2 revealed the catheter hubs should be disinfected for “10 seconds”. Interview revealed that PCT #2 did not disinfect the catheter hubs per facility policy. Interview on 12/09/2024 at 1500 with the Manager of Clinical Services and the Facility Administrator revealed the staff were expected to scrub each catheter hub with an alcohol pad for fifteen (15) seconds per facility policy. Interview revealed the staff failed to follow the facility policy. 2. Review on 12/09/2024 of the facility policy/procedure titled “Central Venous Catheter (CVC) With Clearguard HD Antimicrobial End Caps Procedure” effective October 2024 revealed “... 8. Holding catheter with the non-dominant hand and using aseptic technique, clean exit site with 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol swab for minimum of 30 seconds... Then wait 60 seconds for air dry time.” Observation on 12/09/2024 at 1320 in the patient treatment area revealed PCT #2 entered Station #8 and initiated CVC exit site care for dialysis treatment with a CVC. PCT #2 cleansed the CVC exit site and area around site with 2% Chlorhexidine for 15 seconds and allowed to dry for forty-five (45) seconds. Observation revealed that the PCT failed to disinfect the CVC exit site for thirty (30) seconds and allow the exit site to dry for sixty (60) seconds per facility policy. Interview on 12/09/2024 at 1356 with PCT #2 revealed that the technician believed that the site was disinfected for 30 seconds. The interview revealed the technician did not use the clock when checking disinfect time. The interview confirmed that PCT #2 did not follow the facility policy. Interview on 12/09/2024 at 1500 with the Manager of Clinical Services and the Facility Administrator revealed the staff were expected to disinfect the CVC catheter exit site with Chlorhexidine for 30 seconds and allow to dry for 60 seconds prior to applying new dressing per facility policy. Interview revealed the staff failed to follow the facility policy.”

“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 #1; Station #12, PCT #2). Findings included: Review on 12/09/2024 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 12/09/2024 at 1215 in the patient treatment area revealed PCT #1 entered Station #6 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #1 performed hand hygiene and applied clean gloves. The PCT #1 cleansed the arterial and venous access sites simultaneously with one Povidone Iodine pad for less than 10 seconds. PCT #1 allowed the access sites to dry for 2 minutes before cannulation. Observation revealed PCT #1 failed to disinfect each access site with Povidone Iodine for 30 seconds per the facility policy. Interview on 12/09/2024 at 1230 with PCT #1 revealed that each site should be disinfected for 30 seconds. Interview revealed that PCT #1 disinfected the access sites at the same time using only one (1) Povidone Iodine pad. Interview revealed PCT #1 failed to disinfect the access sites per facility policy. Interview on 12/09/2024 at 1500 with the Manager of Clinical Services and the Facility Administrator 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 12/09/2024 at 1349 in the patient treatment area revealed PCT #2 entered Station #12 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #2 performed hand hygiene and applied clean gloves. The PCT #2 disinfected the arterial access site with Povidone Iodine for less than fifteen (15) seconds. PCT #2 disinfected the venous access site with Povidone Iodine for less than 15 seconds. 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 12/09/2024 at 1356 with PCT #2 revealed that each site should be disinfected for 30 seconds. Interview revealed that PCT #2 disinfected each access site with Povidone Iodine pad for less than 30 seconds. Interview revealed PCT #2 failed to disinfect the access sites per facility policy. Interview on 12/09/2024 at 1500 with the Manager of Clinical Services and the Facility Administrator 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.”