322507 Silver City Dialysis (Dci)

“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: 28297 Based on observation, interview, and policy review the facility failed to ensure patients washed or sanitized hands after holding access sites (A vascular access is created so that blood can be drawn from the body and run through a dialysis machine, where excess fluid and toxins are removed from the blood. (i) The filtered blood then flows back through the access into the body) for one of three survey days. The failure for patients to wash or sanitize hands after holding access site had the potential for cross contamination and could affect 27 in-center patients. Findings include: Observation on 08/21/24 at 10:15 AM revealed Patient (P) 4 at Station 16 applied pressure to the left lower arm access site until bleeding had stopped. When finished the patient walked to the scale to retrieve his/her weight. Certified Hemodialysis Technician (CHT) 1 assisted the patient to the scale to retrieve his/her weight and escorted the patient to the lobby. The patient did not wash or sanitize hands and CHT1 did not instruct or encourage the patient to wash or sanitize hands. During an interview on 08/21/24 at 10:30 AM, CHT1 acknowledged P4 did not wash or sanitize hands after holding access site and he/she did not instruct or encourage the patient to prevent cross contamination. During an interview on 08/23/24 at 11:45 AM the Charge Nurse stated patients should wash or sanitize hands after holding access sites at the end of treatment to prevent cross contamination of blood borne pathogens. During an interview on 08/23/24 at 11:55 AM the Nurse Manager confirmed the expectation was for patients to wash or sanitize hands after holding access sites to prevent cross contamination. Review of the facility policy titled, “Post-Dialysis Care of the Fistula/Graft.” Revised December 31, 2019, indicated, “ ...Patients is to remove glove and perform hand hygiene ...””

“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: 28297 Based on observations, interview, review of facility policy, and Manufacture Directions for Use, the facility failed to follow the recommendations for dialysis (an artificial means of kidney function that removes the waste and excess fluid from the blood by passing it through a filter) treatments by not maintaining the arterial drip chambers (a pressure and air monitoring component of the dialysis bloodline tubing) fluid levels at 85-95% full for one of three survey days. Failure to follow the Manufacture Directions for Use (DFU) had the potential to result in equipment malfunction and/or failure and negatively impact the safety and wellbeing of the 27 patients receiving dialysis treatments in this facility. Findings include: 1. Observation of the hemodialysis treatment area on 08/21/24 revealed the following: At 10:20 AM, the arterial drip chamber fluid levels were less than 25% full at Station 4. At 10:25 AM, the arterial drip chamber fluid level was less than 25 % at Station 9. At 2:10 PM, the arterial drip chamber fluid level was less than 10 % at Station 3, and less than 25% at Station 4 and Station 11. During an interview on 08/21/24 at 2:15 PM the Charge Nurse confirmed the arterial drip chamber fluid level was not at the appropriate level at Stations 3, 4, 9, and 11 and should be at ¾ full to prevent air from getting into the extracorporeal system (dialysis lines and dialyzer). During an interview on 08/23/24 at 11:55 AM PM the Nurse Manager confirmed the expectation was for the arterial drip chambers to be 75% to 85% full to prevent air from getting into the extracorporeal system. Review of the facility’s policy “Set-Up, Priming and Treatment Initiation with a Single Use Dialyzer Utilizing Fresenius 2008 K, K2 and T Dialysis Delivery System with Combiset Bloodlines,” indicated, “ ...Fill arterial drip chamber 90% full using level adjust key ...” Review of the manufacture directions for use (DFU) provided by the facility for “Combi Set True Flow Series Hemodialysis Blood Tubing Set with Priming Set and Transducer Protectors,” indicated, “ ...Prime pre-pump, arterial chamber 85-95% full, post pump arterial and venous chamber 65-75% full ...During Treatment Periodically check the extracorporeal circuit for any evidence of possible Separation or leak. Maintain fluid level in pre-pump arterial chamber at 85%-95% full, post pump arterial and venous chambers at 65-75% full ...””