Davita Smyrna Dialysis

“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: 40606 Based on facility policy review, observation and interview, the facility failed to ensure patients, after the hemodialysis treatment ended, performed disinfection of their hands prior to exiting the treatment area for 3 of 6 observations of hand disinfection at the end of treatment. The facility failed to ensure staff followed appropriate infection control measures prior to accessing an arterio-venous fistula (a surgically created connection between an artery and vein used for hemodialysis access) for 1 patient of 3 patients observed for vascular access cannulation (insertion of 2 needles to access the bloodstream for the dialysis treatment). The findings include: Review of the facility policy titled “AV [arterio-venous] Fistula or Graft Cannulation with [name of needle device] and Administration of Heparin Loading Dose” dated 10/2022, showed “...Perform inspection, auscultation [listen with stethoscope] and palpation [feel] on the entire length of access...Locate and palpate the needle cannulation sites prior to skin preparation...cleanse the site applying skin antiseptic [i.e.70% Alcohol]...for 60 seconds and allow to dry 15 seconds prior to cannulation...Do not palpate insertion sites once area has been prepped...If site has become contaminated, prep insertion site as described...” Review of the facility policy titled “Infection Control for Dialysis Facilities” dated 4/2023, showed “...Purpose...To minimize the spread of infections or bloodborne pathogens in the dialysis facility...Patients and caregivers will be encouraged to wash their hands and access extremity upon entering the treatment area...Perform hand hygiene after treatment before leaving treatment area...” During an observation of the dialysis treatment area, with 8 patients and 3 staff members present, on 4/15/2024 at 10:05-11:05 AM, the patients who finished their treatments in stations 5, 7 and 2, exited their stations without sanitizing their hands, went to the scale, touched the digital pad to obtain post treatment weights, and exited the treatment area without disinfecting their hands. During an observation on 4/15/2024 at 11:05-11:15 AM, Patient Care Technician (PCT) #1, at station 5, prepared the second shift patient for initiation of dialysis. The PCT disinfected the first needle site with a 70% alcohol prep pad for 60 seconds and inserted the dialysis needle. The PCT disinfected the 2nd needle site with a 70% alcohol prep pad for 60 seconds then touched the access site in the center. The PCT inserted the dialysis needle into the contaminated needle site and secured the needle with tape. During an interview on 4/15/2024 at 11:25 AM, the PCT verbally reviewed steps for cannulation and then confirmed the access site was cross contaminated by touching it prior to cannulation. The PCT stated she did not follow the facility’s policy for cannulation a fistula access. During an interview on 4/16/2024 at 4:04 PM, the Group Facility Administrator (GFA) confirmed patients were expected to adhere to the facility’s handwashing policy and sanitize their hands prior to leaving the treatment area. The GFA also confirmed the observation of the PCT showed the PCT failed to follow the facility’s infection control procedures by touching an area of a dialysis access after being cleaned with 70% alcohol prep pads and prior to cannulation.”

“PA-DIALYSIS ACCESS TYPE & MAINTENANCE CFR(s): 494.80(a)(8) The patient’s comprehensive assessment must include, but is not limited to, the following: (8) Evaluation of dialysis access type and maintenance (for example, arteriovenous fistulas, arteriovenous grafts and peritoneal catheters). This Standard is not met as evidenced by: 18784 Based on facility policy review, observation and interview, the facility failed to follow safety procedures to check for pulsation of the hemodialysis access in 1 of 1 first shift patients observed with a clamp used at the end of the dialysis treatment. The findings include: Review of the facility’s policy “Utilizing Vascular Access Clamps” showed “...6. During use, thrill [a vibration that can be felt] and bruit [an audible vascular sound from turbulent blood flow] will be checked above and below the clamp.” Observation of first shift patients during termination of dialysis on 4/15/2024 at 10:26 AM, revealed the Registered Nurse (RN) #1 removed the second dialysis access needle of the first shift patient seated at station 6, applied pressure as the clamp was placed over the needle site and exited the station. Interview with RN #1 on 4/15/2024 at 10:58 AM, at the nursing station, confirmed she had left station 6 after the clamp was applied without checking for the thrill and bruit above and below the clamp.”