Fresenius Kidney Care of Nashua

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 43408 Based on observations, and facility policy review, it was determined that the facility failed to ensure gloves were worn when caring for the patient or touching the patient’s equipment at the dialysis station and failed to ensure that staff removed gloves and performed hand hygiene between each patient or station. Findings include: Review on 7/30/24 of the facility policy titled, “Hand Hygiene”, published 11/6/23, revealed: “ ...Hands will be decontaminated using alcohol-based hand rub or by washing hands with antimicrobial soap and water...immediately after removing gloves...” Review on 7/30/24 of the facility policy titled, “Personal Protective Equipment”, published 2/14/18, revealed “ ...Disposable gloves must be used: ...when touching any part of the dialysis machine or equipment at the dialysis station ...Change gloves and practice hand hygiene between each patient and/or station to prevent cross-contamination...” Observation on 7/29/24 at approximately 8:30 a.m. of Station #5 revealed Staff B (Registered Nurse) using the key board at the dialysis machine with ungloved hands. Observation on 7/29/24 at 12:04 p.m. of Staff C (Patient Care Technician) revealed Staff C went to Station #18 and donned one glove to their right hand without performing hand hygiene. Staff C silenced the alarm on the machine with the gloved right hand. Observation on 7/29/24 at 12:05 p.m. of Staff C revealed Staff C did not perform hand hygiene after doffing gloves at Station #18 and before donning gloves at Station #4. Observation on 7/29/24 at 12:08 p.m. at Station #4 revealed Staff B adjusted the blood pressure cuff on the left arm of Patient #2 with ungloved hands. 26364 Observation on 7/29/24 at approximately 1:00 p.m. of Staff A (Patient Care Technician), during set up of Station #7, revealed that Staff A moved the large trash can away from Station #7 wearing gloves. Staff A returned to Station #7 with out changing their gloves or performing hand hygiene and used the keyboard. Staff A then applied Alcohol Based Hand Rub (ABHR) over the gloves and then finished the set up of the machine. Interview on 7/29/24 at approximately 1:00 p.m with Staff A confirmed that Staff A moved the trash can away from Station #7 and did not change their gloves prior to going back to the station to input data.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 43408 Based on observation, interview, and policy review, it was determined that the End-Stage Renal Disease (ESRD) facility failed to follow standard infection control precautions for cleaning and disinfecting dialysis stations between patients for 1 out of 2 observations of cleaning and disinfection of the dialysis stations. Findings include: Observation on 7/29/24 at 10:45 a.m. at Station #2 revealed Staff C (Patient Care Technician) failed to clean the stethoscope, television remote, the Hansen connectors, and the blood pressure cuff tubing between patients. Further observation revealed that when Staff C was done cleaning and disinfecting Station #2, Staff C brought over supplies for the next patient. At that time, there was a blood spatter remaining on the left outside arm of the dialysis chair from the previous patient. Interview on 7/29/24 at approximately with Staff C confirmed the above observations. Review on 7/30/24 of the facility policy titled, “Cleaning and Disinfecting the Dialysis Station”, published 9/5/23, revealed: “...Procedure...3. Use a cloth wetted with 1:100 bleach solution or EPA-approved disinfectant to clean and disinfect the dialysis station (chair/bed, tables, machines, television, IV [intravenous] pole, B/P [blood pressure] cuff, hand sanitizer dispenser and holder, chaise wall behind chair) Place the chair in Trendelenburg position and open side panels if chair has swing open sides so all surfaces of the chair are accessible. 4. Clean all surfaces. Make the surfaces glisteningly wet and allow to air dry unless otherwise specified by the manufacturer. 5. Give special attention to the cleaning control panel on the dialysis machine and other surfaces that are frequently touched and potentially contaminated with patient’s blood and/or bodily fluids. While wiping, remember to wipe all surfaces of the machine including the air detector changer, blood pump casing, IV pole and whatever the extracorporeal circuit was in contact with the machine...””

“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: 38218 Based on observation, interview, and policy review, it was determined that the dialysis facility failed to follow appropriate infection control recommendations to prevent potential catheter-related infections for 1 out of 2 patients a Central Venous Catheter (CVC) being disconnected from dialysis (Patient Identifier #3). Findings include: Observation on 7/29/24 at approximately 10:30 a.m. revealed that Patient #3 had a field barrier in place under their CVC dialysis access ports while receiving dialysis treatment. During discontinuation of treatment, Staff D (Patient Care Technician) did not place a new clean field barrier under the dialysis access port prior to reinfusing the extracorporeal circuit. Interview on 7/29/24 at approximately 10:30 a.m. with Staff D confirmed the above findings. Review on 7/29/24 of the facility policy titled, “Termination of Treatment Using a Central Venous Catheter and Optiflux Single Use Ebeam Dialyzer”, dated 2/7/22 revealed: “...Prior to Termination: Preparation...5. Ensure that a clean under pad is below the catheter limbs to protect the work area and the clothing...””

“DIALYS PROPORT-MONITOR PH/CONDUCTIVITY CFR(s): 494.40(a) 5.6 Dialysate proportioning: monitor pH/conductivity It is necessary for the operator to follow the manufacturer’s instructions regarding dialysate conductivity and to measure approximate pH with an independent method before starting the treatment of the next patient. This Standard is not met as evidenced by: 38218 Based on observation and interview, it was determined that the dialysis facility failed to measure dialysate potential of hydrogen (pH) with an independent method before starting patient treatment (Patient Identifier #4). Findings include: Observation on 7/29/24 at approximately 12:15 p.m. of the preparation of the hemodialysis machine at Station #2 revealed Staff C (Patient Care Technician) initiated dialysis of Patient #4 when the dialysate from the machine had not been measured for pH. Interview on 7/29/24 at approximately 12:15 p.m. with Staff C confirmed the above findings. Review on 7/29/24 of the facility policy titled, “Regulatory Guidance for Using the 2008 Independent Conductivity and pH”, dated 2/1/23 revealed: “...Determining Independent Verifications...If the machine is not using a bibag disposable, the machine will only independently verify conductivity. Staff must test the dialysate pH using an independent means such as with a hand held meter or pH test strip...””