Davita Dialysis at the Forks

“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: 19410 Based on observation and policy review, the facility failed to ensure staff followed infection control precautions for 2 of 3 patients (Patients #9 and #10) observed during initiation of dialysis with central venous catheter (CVC) access sites. Failure to follow infection control standards for hand hygiene during CVC exit site care and failure to disinfect the CVC hubs for the required contact time during initiation of dialysis may increase the risk of intravascular catheter related infections. Findings include: Review of the policy, “Central Venous Catheter (CVC) with ClearGard [type of CVC cap] HD [hemodialysis] Antimicrobial End Caps Procedure” occurred on 02/04/25. This policy, revised October 2024, stated, “. . . Device Disinfectant and Skin Antiseptic . . . 70% [percent] Alcohol pad . . . Effective for: . . . CVC Hubs . . . Effective Contact Time: 15 second scrub . . . Procedure: 1. Perform hand hygiene per procedure. Put on PPE [personal protective equipment] [gown, gloves, face protection] . . . 4. Remove old dressing and discard. . . . 7. Remove gloves and discard. Perform hand hygiene per procedure and re-glove. 8. . . . using aseptic technique, clean exit site . . . 10. Remove gloves and discard, perform hand hygiene . . . and re-glove. . . . 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 the CVC hub for 15 seconds including the sides, thread and end of hub thoroughly with friction making sure to remove any residue . . .” - Observation on 02/03/25 at 1:50 p.m. at Station #3 showed a staff member (#9) disinfected Patient #9’s CVC hubs with an alcohol pad for approximately five to six seconds prior to initiating hemodialysis. The staff member failed to disinfect the catheter hubs for 15 seconds. - Observation on 02/03/25 at 2:30 p.m. at Station #10 showed a staff member (#5) performed hand hygiene, donned gloves, and removed and discarded Patient #10’s old CVC dressing. Without removing the gloves, the staff member (#5) cleaned Patient #10’s exit site and CVC limbs (catheter tubing extending from the exit site). The staff member failed to remove gloves and perform hand hygiene after removing Patient #10’s old CVC dressing and prior to cleaning the CVC exit site and limbs. The staff member (#5) then removed gloves, performed hand hygiene, and donned gloves. The staff member (#5) disinfected Patient #10’s CVC hubs with an alcohol pad for approximately ten seconds prior to initiating hemodialysis. The staff member failed to disinfect the catheter hubs for 15 seconds.”

“PE-EQUIPMENT MAINTENANCE-MANUFACTURER’S DFU CFR(s): 494.60(b) The dialysis facility must implement and maintain a program to ensure that all equipment (including emergency equipment, dialysis machines and equipment, and the water treatment system) are maintained and operated in accordance with the manufacturer’s recommendations. This Standard is not met as evidenced by: 39211 Based on observation, policy review, and staff interview, the facility failed to maintain the integrity of the dialysis chair coverings for 6 of 15 hemodialysis chairs (Stations #1, #4, #6, #8, #13, and #15) observed in the dialysis treatment area. Failure to maintain the integrity of the chair coverings limited the facility’s ability to effectively clean and disinfect the chairs and prevent cross-contamination. Findings include: Review of the policy “Infection Control for Dialysis Facilities” occurred on 02/05/25. This policy, revised April 2023, failed to include monitoring or inspection of hemodialysis chair coverings to ensure proper cleaning and disinfecting of surfaces. Observation on all days of survey showed hemodialysis chairs worn with cracks and tears on the seats at stations #1, #4, #6, #8, #13, and #15. During an interview on 02/05/25 at 12:10 p.m., two administrative staff members (#1 and #2) confirmed the above listed stations chairs seat coverings cracked and torn leaving them an uncleanable surface.”

“PQ-PCT-STATE REQUIREMENTS & HS DIPLOMA CFR(s): 494.140(e)(1),(2) Patient care dialysis technicians must- (1) Meet all applicable State requirements for education, training, credentialing, competency, standards of practice, certification, and licensure in the State in which he or she is employed as a dialysis technician; and (2) Have a high school diploma or equivalency; This Standard is not met as evidenced by: 19410 Based on review of personnel records, review of the North Dakota Administrative Code, and review of the North Dakota Century Code, the facility failed to register 1 of 1 dialysis technician reviewed (Staff #11) as an unlicensed assistive person (UAP) as required by the State. Failure to ensure dialysis technicians meet State requirements for registration has the potential to place patients at risk of harm. Findings include: The North Dakota Administrative Code Chapter 54-01-03-01 Definitions states, “. . . 77. ‘Technician’ means an unlicensed assistive person who may perform limited nursing functions within the ordinary, customary, and usual roles in the person’s field. Examples may include . . . dialysis technicians . . . 79. ‘Unlicensed assistive person registry’ means a listing of all persons who are authorized by the board or included on another state registry, which has been recognized by the board to perform nursing interventions delegated and supervised by a licensed nurse. . . .” The North Dakota Century Code Nurse Practice Act, Chapter 43-12.1 states, “. . . 43-12.1-02. Definitions. . . . 9. ‘Unlicensed assistive person’ means an assistant to the nurse, who regardless of title is authorized to perform nursing interventions delegated and supervised by a nurse. 43-12.1-03. License or registration required . . . Any person who provides nursing care to a resident of this state must hold a current license or registration issued by the board. It is unlawful for a person to . . . assist in the practice of nursing in this state unless that person is currently licensed or registered under this chapter. . . .” Review of personnel files occurred on the morning of 02/05/25. The file for a patient care technician (Staff #11) lacked evidence of registration as an unlicensed assistive person (dialysis technician) with the North Dakota Board of Nursing. 39211”