Davita Mt Juliet 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 4 of 6 observations. The findings include: 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...” Observations on 1/6/2025, from 1:00-2:00 PM, revealed the dialysis treatment area had 9 patients seated in various stations and 3 staff members present and providing patient care. Further observation revealed patients who had finished their dialysis treatment in stations 4, 5, 6 and 10 had exited their stations without sanitizing their hands. These patients went to the scale, obtained post treatment weight, and failed to disinfect their hands prior to exiting the treatment area into the community. During an interview on 1/7/2025 at 4:04 PM, the Interim Group Facility Administrator (IGFA) confirmed patients were expected to adhere to the facility’s handwashing policy; patients’ must sanitize their hands prior to leaving the treatment area to prevent the potential spread of disease or contamination.”

“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: 40606 Based on facility policy review, observation and interview, the facility failed to ensure staff followed appropriate infection control measures prior to accessing a central venous catheter (CVC-a surgically inserted dialysis access) for 1 patient of 3 patients observed for discontinuation of dialysis using a CVC catheter. The findings include: Review of the facility policy titled, “CENTRAL VENOUS CATHETER (CVC) WITH [name of CVC catheter cap device] PROCEDURE,” dated 11/2024, showed “...Perform hand hygiene per procedure...Put on PPE [personal protective equipment] and provide a mask to the patient...Teammate and patient will wear masks covering the nose and mouth during this procedure...” Observations on 1/6/2025 from 2:05-2:30 PM, revealed Registered Nurse (RN) A at station 5, prepared to terminate the dialysis treatment for a patient with a CVC. Continued observation at 2:08 PM, revealed RN A disconnected 1 of the 2 lumens [tubes] of the CVC, scrubbed the end of the CVC lumen with an alcohol disinfectant pad for 30 seconds. RN A proceeded to connect a syringe to the end of the CVC lumen. Further observation revealed at 2:09 PM, a Certified Clinical Hemodialysis Technician (CCHT) had retrieved a face mask for the patient in station 5 and proceeded to acquire the attention of RN A. RN A received the face mask and placed it in position to cover the patient’s nose and mouth. RN A completed the termination of the treatment, with everyone in close proximity wearing face masks, while the CVC was sanitized and capped to complete the procedure. During an interview on 1/7/2025 at 4:04 PM, the IGFA confirmed the observation of RN A, during termination of dialysis for a patient with CVC access, failed to follow the facility’s infection control procedures when a mask was not provided to cover the patient’s nose and mouth while the CVC was open to air during termination.”