Dci Gaffney

“IC-SANITARY ENVIRONMENT CFR(s): 494.30 The dialysis facility must provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit and any adjacent hospital or other public areas. This Standard is not met as evidenced by: 41743 Based on observations, interviews, review of facility policy, entitled, “TERMINATION OF DIALYSIS WITH A FISTULA OR GRAFT”, and interview, 2 of 2 Registered Nurses (RN) failed to re-sanitize the patient’s access sites after touching the access site prior to insertion. (RN #2 and #3). Staff failed to ensure random patients performed hand hygiene after holding their access sites sites at the end of their dialysis treatments and then exiting the dialysis treatment room for 5 of 5 random patients observed. (Random patients A, B, C, D, and E) The findings include: Observations on 01/09/2024 between 10:15 AM and 11:35 AM revealed RN #3 sanitized the patient’s access site with alcohol, and then touched the access site with gloved fingers prior to insertion of the catheter without re-sanitizing the patient’s access site. Observations showed RN #2 sanitized the patient’s access site with alcohol, and then touched the patient’s access site with gloved fingers prior to insertion of the catheter without re-sanitizing the patient’s access site. Observations at 10:24 AM revealed Random Patient A exiting the dialysis treatment room after holding a gauze to the access site wearing gloves after the dialysis treatment without performing hand hygiene. Observations at 11:11 AM revealed Random Patient B exiting the dialysis treatment room after holding gauze to the access site wearing gloves at the end of the dialysis treatment without performing hand hygiene. Observations on 01/10/2024 between 10:00 AM and 11:03 AM revealed Random Patient C at 10:05 AM, Random Patient D at 10:20 AM, and Random Patient E at 10:37 AM left the dialysis treatment room after holding their access site with with gauze and wearing gloves at the end of their dialysis treatment without performing hand hygiene. On 01/10/2024 at 12:50 PM, Area Operations Director #1 reported “Should know better ...need more training ...young staff”. Facility policy, entitled, “ TERMINATION OF DIALYSIS WITH A FISTULA OR GRAFT”, revealed, “Patient should be given a glove to use when holding pressure and instruct patient to wash or sanitize hands after removing gloves from holding pressure”.”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 41743 Based on observations, interview, and review of facility policy, entitled, “DISINFECTION OF REUSABLE EQUIPMENT AND SURFACES IN THE DIALYSIS SETTING”, 3 of 3 Registered Nurses (RN) failed to follow accepted principles of infection control to prevent potential cross transmission of infectious agents in the renal setting when using stethoscopes between patients. (RN #1, #2, and #3) The findings include: Observations on 01/09/2024 and 01/10/2024 revealed RN #1, #2 and #3 retrieving stethoscopes lying on the nurse station counter, placed the stethoscope around their neck, assessed the patient with the stethoscope, replaced the stethoscope around their neck. RN #1, #2, and #3 did not sanitize the stethoscope before assessing the next patient. RN #1 laid the stethoscope back onto the nurse station counter without sanitizing the equipment. On 01/10/2024 at 12:50 PM, Area Operations Director #1 reported “Need to sanitize.” Facility policy, entitled, “DISINFECTION OF REUSABLE EQUIPMENT AND SURFACES IN THE DIALYSIS SETTING”, revealed, “All reusable equipment, surfaces, and ancillary equipment will be disinfected after each use”.”

“IC-HANDLING INFECTIOUS WASTE CFR(s): 494.30(a)(4)(i) [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- (i) Handling, storage and disposal of potentially infectious waste; This Standard is not met as evidenced by: 41743 Based on observations and interview, the dialysis facility failed to use Sharps containers safely with the potential of injury or waste contamination by overloading biohazard Sharps containers. The finding includes: Observations on 01/10/2024 revealed red Sharps containers located at dialysis station #22, #23, #25 and #27 were filled past the fill line near top of the Sharps container. On 01/10/2024 at 12:50 PM, Area Operations Director #1 reported, “Need replaced.””

“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: 41743 Based on observations, interviews, and review of facility policy, entitled, “DISINFECTION OF REUSABLE EQUIPMENT AND SURFACES IN THE DIALYSIS SETTING”, one of three Registered Nurses (RN) failed to empty and disinfect prime buckets between patients to prevent potential spread of pathogens. The finding includes: Observations on 01/10/2024 revealed Registered Nurse (RN) #3 failed to empty and sanitize the prime bucket at dialysis station #28 between patients. On 01/10/2024 at 12:50 PM, Area Operations Director #1 reported “Need training.” Facility policy, entitled, “DISINFECTION OF REUSABLE EQUIPMENT AND SURFACES IN THE DIALYSIS SETTING”, revealed, “Wipe clean entire machine surface area including prime bucket and blood pressure cuff after each patient use.””

“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: 41743 Based on observations, interviews and review of manufacturer’s instructions, entitled, “OPERATION OF PORTABLE MYRON L CONDUCTIVITY METER”, the dialysis facility staff failed to follow manufacturer’s instructions regarding calibration of Myron meter L D6 at end of day and capping pH sensor. The finding includes: Record review on 01/08/2024 of Myron Meter L D6 record for meters 7, 8, and 9 calibrations observed in the dialysis treatment room revealed no end of day calibrations documented by staff. On 01/08/2024 at 12:16 PM, the Biomed Technician revealed, “ Should be done at start of day, end of day, and in between when needed”, The Biomedical Technician verified the finding. Observations on 01/09/2024 and 01/10/2024 revealed Myron Meter 7 and 8 with an uncapped pH sensor. Manufacturer ‘s instructions, entitled, “OPERATION OF PORTABLE MYRON L CONDUCTIVITY METER”, revealed, “ALWAYS perform a calibration check of the pH sensor at the beginning and end of each workday or more often if required by your clinic’s internal procedures ...The protective cap is removed and the pH/ORP sensor well and conductivity cell are filled and rinsed with the sample enough times to completely replace the storage solution ...After use, the pH/ORP sensor well must be filled with Myron L Storage Solution, and the protective cap reinstalled securely ...Both the pH/ORP sensor well and the conductivity cell MUST be rinsed and filled at least 3 times with sample before each measurement is taken ...Fresh dialysis quality water should be used to rinse the plunger and cell cup of the D1 meter ...When you are finished with the D1 meter, RINSE thoroughly with dialysis quality water”.”

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 41743 Based on observation, interviews, and review of facility policies, entitled, “Handling, Use, and Storage of Sterile Injectable” and “Medications, USE OF SINGLE DOSE MEDICATION VIALS”, the dialysis facility failed to remove expired supplies from staff access, failed to keep medications in a secured area and to label multidose medication vials per facility policy. The findings include: Observations on 01/08/2024 between 9:08 AM and 11:10 AM revealed multidose Heparin vials and syringes left unattended on medication counter at nurse station and unlocked medication drawer containing unopened Heparin vials and syringes. Expired supplies in the nurse station: one box of micropore paper tape expired 10/2020, and in the lab area: 235 yellow urinalysis tubes expired 10/31/2023 and 12/31/2023, and in the emergency evacuation: box 20 IV administration sets expired 10/16/2023. All expired supplies verified by Registered Nurse (RN) #1 at 10:30 AM. Observations on 01/09/2024 revealed syringes and mutidose medication vials left unattended on countertops and medication drawers unlocked. Observations on 01/20/2024 revealed syringes and mutidose medication vials left unattended on countertops and medication drawers unlocked and opened multidose vial on counter without time, date, or initials when opened. Facility policy, entitled, “Handling, Use, and Storage of Sterile Injectable and Medications”, revealed, “All medications and biologicals are to be stored in a secure and orderly manner without crowding”. Facility policy entitled “USE OF SINGLE DOSE MEDICATION VIALS” reveals, “Date, time and initial immediately after opening vial”.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 41743 Based on record reviews, interview, and review of facility policy, entitled, “ FRESENIUS INTERNAL BLOOD PRESSURE, PULSE and MAP MONITOR 2008H”, the facility staff failed to monitor Blood Pressure (BP) and patient status every 30 minutes for 2 of 7 patient charts. (Patient #4 and #5) The finding includes: On 01/09/2024 at 1:25 PM, chart review for Patient #4 revealed documentation dated 12/20/2023 dialysis treatment for vital signs at 11:00 AM: BP 142/98 and at 11:54 AM: BP of 141/104. Dialysis Treatment dated 12/22/2023 revealed vital signs at 11:28 AM: BP 101/58 and at 12:23 PM: BP of 108/71. This was 55 minutes between patient assessments. On 01/09/2024 at 2:03 PM, Area Operations Director #2 verified the finding. On 01/09/2024 at 11:50 AM, chart review for Patient #5 revealed documentation dated 12/18/2023 treatment for vital signs at 11:43 AM: BP 117/58 and at 12:45 PM: BP of 149/64. This was 62 minutes between patient assessments. On 01/09/2024 at 2:18 PM, Area Operations Director #2 verified the finding. Facility policy entitled “ FRESENIUS INTERNAL BLOOD PRESSURE, PULSE and MAP MONITOR 2008H” reveals, “Blood pressure and heart rated (sic) are to be monitored every 30 minutes and are necessary during a hemodialysis treatment to alert of any complications during treatment”.”