Usrc Central Fort Worth

“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: 48653 Based on observation, record review, and staff interviews, the facility staff failed to monitor and provide a sanitary environment to minimize the transmission of infectious agents within the dialysis centers in-center treatment area. During a tour of the facility’s in-center treatment area on 06/03/2024 at 12:00 PM with Staff # 2, and # 3 the surveyor observed the following infection control issues: In-Center Treatment Area Two hemodialysis machines (#105353 and # 105643) were observed to have dirt and debris on the back and bottom ledge of the machines. There was also a brown substance on the back of machine # 105353. The machines were designated as clean. The laboratory specimen refrigerators located on the in-center treatment floors were dirty on the inside with dirt, dust, and hair found inside. There was a large build-up of frost on the inside of the freezer in both laboratory refrigerators. The build-up of ice was not able to be cleaned and could affect the temperature regulation of the refrigerator. The back side of the in-center treatment wall located behind the emergency boxes was damaged. There were cracks and exposed building materials that could not be adequately cleaned and disinfected. There were dead bugs on the floor next to the crack in the wall. The emergency code cart located behind the nurse’s station was dirty with orange and brown substances on the bottom ledge of the cart. There was a build-up of dust and dirt on the bottom of the code cart. The emergency code cart had three Ambu (emergency airway) bags that were opened and not properly sealed. There was no way to identify if the Ambu bags had been used previously. A review of the facility’s policy, “Infection Control and Precautions for All Patients” with a revision date of 07/2023 revealed, “PURPOSE: To educate staff on general guidelines in the prevention of infection within the dialysis facility. 3. Clean areas will be clearly designated and separated from contaminated areas and unused supplies and equipment ... 15. Cleaning and disinfection: a. Clean and disinfect the dialysis station (e.g., chairs, beds, tables, integrated keyboards, dialysis machines, ancillary equipment) after patient has vacated the station. i. Give special attention to cleaning control panels on the dialysis machines and other surfaces that are frequently touched and potentially contaminated with patients’ blood. ii. If station has a privacy curtain and it becomes visibly soiled, curtain will need to be cleaned and disinfected with 1:100 bleach wipe, laundered or replaced. iii. Discard all fluid and clean and disinfect all surfaces and containers associated with the prime waste (including buckets attached to the machines). b. The following areas will undergo routine cleaning and disinfection at the end of the day or more frequently as needed: i. Nursing stations and common biomed desk/work areas. ii. High touch areas (e.g., screening iPads, door or scale handles, keyboards, wheelchair arms). c. Any blood spills must be cleaned/disinfected immediately and thoroughly. d. Refer to policy C-IC-0080 Disinfection and Cleaning of Dialysis Machine Equipment, for bleach instructions ...” During an interview with Staff # 2 and # 3 on 06/03/2024 at 2:00 PM, Staff # 2 confirmed the facility staff had not properly cleaned and disinfected the dialysis machines which had been designated as clean. Also, Staff # 2 and # 3 acknowledged the infection control findings found in the in-center treatment areas.”

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 48653 Based on observation, record review, and staff interviews, the facility staff failed to ensure medications maintained in the facility were properly safeguarded and not accessible to unauthorized persons. During a tour of the facility’s in-center treatment area on 06/03/2024 at 12:00 PM with Staff # 2 and # 3, the surveyor observed a 2-milliliter (ml) syringe with 1000 units of Heparin (blood thinning medication) in it on the bottom ledge of the hemodialysis machine between the biohazard bin and the machine. The Heparin was unsecured and not safeguarded from unauthorized persons. A review of the facility’s policy, “Guidelines for Administration of Medications” with a revision date of 04/2024 revealed the following, “PURPOSE: To maintain the safety and comfort of the patient about the administration of a medication and to administer medications in accordance with a physician’s order and protocol where applicable, per state and federal regulations, and according to the following procedure. PROCEDURE: 10. Medication Preparation Area: a. Medications will be prepared and distributed from a designated clean area. b. Do not use medication carts/trays for distributing medications from the preparations area to the patient station. NOTE: Medications will not be left unattended/unsecured at any time in the patient treatment area (e.g., patient stations, counters, desks, etc.) ...” During an interview with Staff # 3 on 06/03/2024 at 12:30 PM, Staff # 3 acknowledged the syringe with Heparin was unsecured and not properly safeguarded.”

“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: 48653 Based on observation and staff interviews, the facility staff failed to monitor and provide a safe environment to store outside hazardous waste. These findings had the likelihood to cause harm by increasing the risk of infectious waste being made available to the public outside of the facility. During a tour of the facility on 06/03/2024 at 11:45 AM, the surveyor observed the dumpster was unsecured and could allow for the pilfering of hazardous waste by outside people and animals. There were several homeless people seen in the parking lot outside of the facility during the survey. During an interview with Staff # 2 and # 3 on 06/03/2024 at 11:45 AM, Staff # 2 and # 3 acknowledged the outside dumpster was not secured and there were homeless people in the parking lot.”

“H20 STORAGE & DISTRIBUTION-DESIGN CFR(s): 494.40(a) 5.3 Water storage and distribution 5.3.1 General: Design A water storage and distribution system should be designed specifically to facilitate bacterial control, including measures to prevent bacterial colonization and to allow for easy and frequent disinfection. This Standard is not met as evidenced by: 48653 Based on observation, record review, and interview, the facility’s biomedical staff failed to ensure the water storage system was secured and without leaks. This deficient practice had the likelihood of exposing the R/O (reverse osmosis) water system to bacterial contaminants. Findings Include: During a tour of the facility’s water room with Staff # 2 and Staff # 3 on 06/03/2024 at 11:50 AM, the surveyor observed water dripping on the floor beneath the R/O system’s membranes. There was a small puddle of water located under the front portion of the R/O and water was observed to be leaking from the R/O system. During an interview with Staff # 2 and # 3 on 06/03/2024 at 11:50 AM in the facility’s water room, Staff # 2 acknowledged the water leak and informed the biomedical technician staff.”

“ACID CONC DIST-CONC LABELED & COLOR-CODED RED CFR(s): 494.40(a) 5.5.3 Acid concentrate distribution systems: labeled & color-coded red Acid concentrate delivery piping should be labeled and color-coded red at the point of use (at the jug filling station or the dialysis machine connection). All joints should be sealed to prevent leakage of concentrate. If the acid system remains intact, no rinsing or disinfection is necessary. More than one type of acid concentrate may be delivered, and each line should clearly indicate the type of acid concentrate it contains. This Standard is not met as evidenced by: 48653 Based on observation and staff interview, the facility’s biomedical staff failed to identify and promptly correct an acid leak present in the facility’s water room. During a tour of the facility’s water room with Staff # 2 and # 3 on 06/03/2024 at 11:50 AM, the surveyor observed a large acid leak under the acid mixer. There was a large amount of dried white crystals around the piping of the acid mixer. During an interview with Staff # 2 and Staff # 3 on 06/03/2024 at 11:50 AM, Staff # 2 and # 3 acknowledged the acid leak present under the acid mixer.”

“PE-HD PTS IN VIEW DURING TREATMENTS CFR(s): 494.60(c)(4) Patients must be in view of staff during hemodialysis treatment to ensure patient safety, (video surveillance will not meet this requirement). This Standard is not met as evidenced by: 48653 Based on observation, record review, and staff interview, the facility’s direct care staff failed to ensure the patient’s arteriovenous fistula access was always visible during treatment on 3 (Patient # 28, # 29, and # 30) of 10 patient observations. Ensuring proper visualization of the arteriovenous fistula access is important for the early recognition and prevention of bleeding from the patient’s access site. During a tour of the facility’s in-center treatment area on 06/03/2024 at 12:10 PM with Staff # 2 and # 3, the surveyor observed the following, Patient # 28 was receiving hemodialysis treatment. The patient’s arteriovenous fistula access was covered with a blanket and was not visible to the direct care staff. The surveyor observed the patient’s access covered for more than 10 minutes without any intervention from the direct care staff. Patient # 29 was receiving hemodialysis treatment and the patient’s arteriovenous fistula access was covered with a blanket. The surveyor observed the patient’s arteriovenous access covered without any intervention from direct care staff. Patient # 30 was receiving hemodialysis treatment and the patient’s arteriovenous fistula access was covered with a blanket. The surveyor observed the patient’s arteriovenous access covered without any intervention from direct care staff. A review of the facility’s policy, “Intradialytic Monitoring of Patient” with a revision date of 09/2020 revealed, “PURPOSE: The patient will receive a safe, effective and comfortable treatment. MONITORING: Direct patient care staff will monitor the following parameters during each dialysis treatment: PATIENT: 1. Must be in direct view of a staff member at all times; if leaving the treatment area for any reason, report off to another staff member and ensure observation of the assigned patients. 2. Vital signs: Obtained and documented at least every 30 minutes and reported to charge nurse if outside of standing orders and/or reportable parameters, refer to C-FORMS- 0081 Reportable Parameters to CN. 3. Volume status: Indicated by changes in BP and HR parameters, lung sounds and presence or reduction of edema. 4. Vascular access: Site clean and dry; venous and arterial pressure monitoring; signs and symptoms of recirculation; signs and symptoms of infiltration. 5. ENSURE PATIENT’S ACCESS, BLOOD LINES AND FACE ARE VISIBLE AT ALL TIMES: a. During every 30 minute monitoring, the access and visualization of the face must be observed. b. If the patient refuses to keep access or face uncovered at all times (including eye shades or hats/caps), the charge nurse will be notified. c. Document patient refusal and charge nurse notifications in the flow sheet. Continued non-adherence will require additional intervention from the interdisciplinary team ....” During an interview with Staff # 2 and # 3 on 06/03/2024 at 12:30 PM, Staff # 2 and # 3 acknowledged that 3 patients receiving hemodialysis treatment at the facility had their access covered and the access was not visible to the direct care staff.”