Davita Coastal Plain 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 2 of 3 observed initiation of hemodialysis treatment with a CVC (PCT #5, Station #14, Station #13) and failed to disinfect a CVC exit site with ExSept Plus (hypochlorite) and allow to dry for two (2) minutes per facility policy for 2 of 2 observed CVC exit sites disinfected with ExSept Plus (PCT #5, Station #14, Station #13). Findings include: A. Review on 06/27/2024 of the facility policy titled “Central Venous Catheter (CVC) With Clearguard HD Antimicrobial End Caps” effective October 2023 revealed “ ... 16. 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.” 1. Observation on 06/26/2024 at 1143 in the patient treatment area revealed PCT #5 entered Station #14 and initiated access of a Central Venous Catheter (CVC). Observation revealed PCT #5 performed hand hygiene, applied clean gloves. Observation revealed PCT #5 cleansed the arterial and venous catheter hubs for 10 seconds. Observation revealed the PCT failed to disinfect the catheter hubs per facility policy. Observation revealed PCT #5 failed to cleanse each catheter hub for 15 seconds per facility policy. Interview on 06/26/2024 at 1150 with PCT #5 revealed “I thought I cleaned the catheter hubs for 15 seconds.” Interview revealed each CVC hub should be cleansed for 15 seconds. Interview revealed PCT #5 did not disinfect the catheter hubs per facility policy. Interview on 06/26/2024 at 1530 with the Manager of Clinical Services 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. Observation on 06/26/2024 at 1225 in the patient treatment area revealed PCT #5 entered Station #13 and initiated access of a Central Venous Catheter (CVC). Observation revealed PCT #5 performed hand hygiene, applied clean gloves. Observation revealed PCT #5 cleansed the arterial and venous catheter hubs for 10 seconds. Observation revealed the PCT failed to disinfect the catheter hubs per facility policy. Observation revealed PCT #5 failed to cleanse each catheter hub for 15 seconds per facility policy. Interview on 06/26/2024 at 1230 with PCT #5 revealed each CVC hub should be cleansed for 15 seconds. Interview revealed PCT #5 did not disinfect the catheter hubs per facility policy. Interview on 06/26/2024 at 1530 with the Manager of Clinical Services 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. B. Review on 06/27/2024 of the facility policy titled “Central Venous Catheter (CVC) With Clearguard HD Antimicrobial End Caps” effective October 2023 revealed “... NOTES: ...first choice for CVC care is 2% Chlorhexidine/70% Alcohol swab. If these agents are contraindicated for a patient, the physician will prescribe an agent for the individual patient and individual supplies will be used in place of the CVC kit, per manufacturer’s recommendations.” Review of policy documentation on use of ExSept Plus (Hypochlorite) revealed saturate 2x2 gauze with 3-5 milliliters and use at least two sterile gauze for site for 60 seconds and allow site to dry for 2 minutes. 1. Observation on 06/26/2024 at 1143 in the patient treatment area revealed PCT #5 entered Station #14 and initiated CVC exit site care for dialysis treatment with a CVC. PCT #5 cleansed the CVC exit site and area around site with ExSept Plus for 30 seconds and allowed to dry for fifteen (15) seconds. Observation revealed that the PCT failed to disinfect the CVC exit site for sixty (60) seconds and allow the exit site to dry for two (2) minutes per facility policy. Interview on 06/26/2024 at 1150 with PCT #5 revealed that the technician did not know that when using ExSept Plus, the site had to be disinfected for 60 seconds and allowed to dry for 2 minutes. The interview confirmed that PCT #5 did not follow the facility policy. Interview on 06/26/2024 at 1530 with the Manager of Clinical Services revealed the staff were expected to disinfect the CVC catheter exit site for 60 seconds and allow to dry for 2 minutes when using ExSept Plus antiseptic per facility policy. Interview revealed the staff failed to follow the facility policy. 2. Observation on 06/26/2024 at 1225 in the patient treatment area revealed PCT #5 entered Station #13 and initiated CVC exit site care for dialysis treatment with a CVC. PCT #5 cleansed the CVC exit site and area around site with ExSept Plus for 30 seconds and allowed to dry for thirty (30) seconds. Observation revealed that the PCT failed to disinfect the CVC exit site for sixty (60) seconds and allow the exit site to dry for two (2) minutes per facility policy. Interview on 06/26/2024 at 1230 with PCT #5 revealed that the technician did not know that when using ExSept Plus, the site had to be disinfected for 60 seconds and allowed to dry for 2 minutes. The interview confirmed that PCT #5 did not follow the facility policy. Interview on 06/26/2024 at 1530 with the Manager of Clinical Services revealed the staff were expected to disinfect the CVC catheter exit site for 60 seconds and allow to dry for 2 minutes when using ExSept Plus antiseptic 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 #21, PCT #3; Station #15,RN #4). Findings included: Review on 06/28/2024 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 06/26/2024 at 1210 in the patient treatment area revealed PCT #3 entered Station #21 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. PCT #3 performed hand hygiene and applied clean gloves. The PCT #3 cleansed the arterial access site with a Povidone Iodine pad for a total of 10 seconds. PCT #3 cleansed the venous access site with a Povidone Iodine pad for a total of 10 seconds. PCT #3 allowed the access sites to dry for 2 minutes before cannulation. Observation revealed PCT #3 failed to disinfect each access site for 30 seconds per the facility policy. Interview on 06/26/2024 at 1220 with PCT #3 revealed that each site should be disinfected for 30 seconds. Interview revealed that PCT #3 thought she had cleaned each access site for 30 seconds. Interview revealed PCT #2 failed to disinfect the access sites per facility policy. Interview on 06/26/2024 at 1530 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 the site to dry for 2 minutes, prior to cannulating. Interview revealed the staff failed to follow the facility policy. 2. Observation on 06/28/2024 at 1005 in the patient treatment area revealed RN #4 entered Station #15 and initiated access of an Arterio-venous fistula/graft (AVF/G) for hemodialysis treatment. RN #4 performed hand hygiene and applied clean gloves. RN #4 disinfected the arterial access site with a Povidone Iodine pad for a total of 20 seconds. RN #4 disinfected the venous access site with a Povidone Iodine pad for a total of 20 seconds. RN #4 allowed the access sites to dry for 2 minutes before cannulation. Observation revealed RN #4 failed to disinfect each access site for 30 seconds per the facility policy. Interview on 06/28/2024 at 1015 with RN #4 revealed that the disinfect contact time was 30 seconds to each access site. Interview revealed that RN #4 thought thought that she had cleaned each access site for 30 seconds. Interview revealed RN #4 failed to disinfect the access sites per facility policy. Interview on 06/26/2024 at 1530 with the Manager of Clinical Services revealed the staff were expected to clean each access site for 30 seconds when using Povidone Iodine pads and allow the site to dry for 2 minutes, prior to cannulating. Interview revealed the staff failed to follow the facility policy.”