Dci Madison

“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: 33763 Based on policy review, observation, and interview, the facility failed to ensure hand hygiene was performed per policy by 1 of 7 (CCHT #1) staff members observed providing direct patient care. The findings included: 1. Review of the facility policy titled, “Standard Precautions & Infection Control” revised on 7/11/2018 revealed, “...Hands will be washed...after gloves are removed...between each glove change, before reaching in the glove box for new gloves...before obtaining supplies from the supply cart...” 2. Observations on the treatment floor on 10/7/2024 at 10:25 AM, revealed CCHT #1 was disinfecting a dialysis station. The CCHT emptied and cleaned the prime waste receptacle then removed her gloves. Without performing hand hygiene, CCHT #1 reached into the glove box for new gloves and put them on. The CCHT then gathered supplies for the next scheduled patient and took them to the dialysis station. During an interview on 10/9/2024 at 7:35 AM, the NM stated hand hygiene should be performed “every time gloves are removed and before putting on new ones.””

“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: 33763 Based on policy review, observation, and interview, the facility failed to ensure dialysis station chairs were fully disinfected between patients by 1 of 2 (CCHT #1) staff members observed cleaning the dialysis chairs. The findings included: 1. Review of the facility policy titled, “Standard Precautions & Infection Control” revised on 7/11/2018 revealed, “...Between patients, clean all equipment with clean towels soaked in bleach water...After patient treatment, clean and disinfect the dialysis station (chairs, beds, tables, machines...)” Observations on the treatment floor at Station #13 on 10/7/2024 at 10:25 AM revealed CCHT #1 was disinfecting the dialysis station. CCHT #1 failed to open the chair arms and disinfect the inside of the chair arms and down the sides of the seat cushion. During an interview on 10/7/2024 at 7:35 AM, the NM verified staff are expected to open the chair arms and disinfect the inside chair arms and down the sides of the seat cushion.”

“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: 33763 Based on policy review, observation and interview, the facility failed to ensure measures to prevent CVC related infections were followed when staff failed to complete CVC dressing changes for 1 of 3 (Patient #1) sampled patients with CVCs and when 1 of 2 (RN #1) RNs observed discontinuing hemodialysis via a CVC failed to place a clean moisture proof barrier under the CVC limbs. The findings included: 1. Review of the facility policy titled, “Central Venous Catheter: Flushing and Heparinization of Unused Catheter” dated 8/1/2017 “ revealed, “...Catheter dressings will be changed per schedule as if the catheter were in use. (Every treatment for standard dressing...)...” Medical record review for Patient #1 revealed an admission date of 7/22/2024 with diagnoses which included End Stage Renal Disease and Type 2 Diabetes Mellitus. The Patient had a CVC as well a maturing AV fistula. Review of the physician’s orders dated 7/22/2024 revealed Patient #1 was to receive hemodialysis treatments 3 times a week. Review of the HD flowsheets dated 9/9/2024 through 10/4/2024 revealed no documentation CVC dressing changes were completed on 9/11/2024, 9/13/2024, 9/16/2024, 9/18/2024, 9/20/2024, 9/23/2024, 9/25/2024, and 10/4/2024. During an interview on 10/8/2024 at 10:05 AM, the NM verified there was no documentation the CVC dressing changes were completed. The NM stated, CVC dressing changes should have been done every time the Patient was in the clinic whether or not it was used.” 2. Review of the facility policy titled, “CV Catheter: Connection and Disconnection” dated 8/1/2017 revealed, “...Disconnection...Assist patient to put on mask, and place fresh moisture-proof barrier under catheter limbs...” Observations on the treatment floor at Station #25 on 10/7/2024 at beginning at 3:36 PM, revealed RN #1 was preparing to discontinue Patient #5’s hemodialysis treatment via a CVC. The Patient had a moisture proof barrier in place under the CVC limbs that was visibly soiled with blood. RN #1 completed the rinse back and disconnection procedure without placing a clean moisture proof barrier under the CVC limbs. During an interview on 10/9/2024 at 7:35 AM, the NM verified a clean moisture proof barrier should be placed under the CVC limbs prior to discontinuing the treatment.”

“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: 33763 Based on policy review, observation and interview, the facility failed to ensure control solutions used to verify and calibrate the conductivity meters were not expired. The findings included: 1. Review of the facility policy titled, “Myron L D6 Meter [water testing machine] Disinfection, Calibration, Use and Storage” dated 2/10/2023 revealed, “...The meter will be verified...daily prior to use, and/or whenever inaccurate readings are suspected or documented on the “Daily Dialysate Meter Log” sheet...Procedure...Confirm that...solutions expiration dates (X2) are not expired...” 2. Observations in the medical supply room on 10/8/2024 at 2:50 PM, revealed the open and in-use pH Standard Buffer Solution [used to calibrate pH meters] had an expiration date of 9/23/2024. There were 2 additional unopened bottles of the solution in the storage cabinet each with an expiration date of 9/23/2024. There was 1 unopened bottle of Conductivity Standard Solution [used to calibrate pH meters] with an expiration date of 1/27/2023 and 2 unopened bottles of Conductivity Standard Solution with expiration dates of 6/5/2024. 3. During an interview on 10/8/2024 at 2:50 PM, the NM confirmed the solutions were expired.”