Fresenius Medical Care Katy

“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: 10802 Based on observation, interview and record review, facility’s direct care staff failed to remove contaminated gloves and wash/ sanitize hands after direct contact with contaminated objects in 4 of 8 staff observed and failed to encourage patient to wash/ sanitize contaminated hands after holding vascular access site post hemodialysis treatment. Patient #s 3 and 4, Registered Nurse K, Registered Nurse (B) Clinical Coordinator (N), and Patient Care Technician (E) Findings: Review of the facility’s current policy and procedure: Hand Hygiene: published 03/17/2023, reference number 47664, version 7 directs the staff as follows: “Hands Will Be ... Decontaminated using alcohol-based hand rub or by washing hands with antimicrobial soap and water. “ Entering and leaving the treatment area ... “ Immediately after removing gloves ... “ After contact with other objects within the patient station or treatment space Hand Hygiene Patients: Patients should perform hand hygiene if able, prior to and after each dialysis treatment ... To help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed.” Patient #3, Registered Nurse (K) On 07/29/2024 at 7:15 a.m. Registered Nurse (K) was observed at the chairside of patient #3 at station #15. The registered nurse was initiating hemodialysis treatment on the patient. Registered Nurse (K) was observed wearing a pair of gloves which she used to lift the footrest of the patient’s chair, covered him with his personal blanket and repositioned the chair. After providing care to the patient, Registered Nurse (K) walked to the nurses’ station, with the donned contaminated gloves, and picked up two clean/ disinfected, blue clamps using her contaminated gloved hands. The registered nurse placed one of the blue clamps on the intravenous pole of station #13 which was terminally cleaned and set up for an on- coming patient. Registered Nurse (K) then returned to Patient # (3’s) chairside, repositioned the patient’s central venous catheter and clamped the patient’s external blood lines wearing the contaminated the used to raise the footrest of the patient. The Surveyor immediately notified Registered Nurse (K) of not removing contaminated gloves and wash/ sanitize her hands. Registered Nurse (K) states “Thank you.” Clinical Coordinator (N) On 07/29/2024 at 10:15 a.m. Facility’s Clinical Coordinator (N) was observed at station # 12 hemodialysis machine #8. The registered nurse was preparing the station for an on coming patient. Observation revealed the registered nurse wearing a pair of gloves retrieved a plastic bag from the floor at the station, removed the contaminated gloves he had donned and went to the clean supply drawer and picked up a roll of tape, broke off a piece of the paper tape and returned it to the clean supply drawer. The Facility’s Clinical Coordinator did not wash/ sanitize his hands after picking up the plastic bag from the floor with his gloved hands. The Surveyor immediately notified him of the break in infection control. The facility’s Clinical Coordinator states “ yes Mam”. Registered Nurse (B) Patient #4 On 07/29/2024 at 10:22 a.m. Registered Nurse (B) was observed at station # 22. The registered nurse was terminating the hemodialysis treatment of Patient #4. The registered nurse picked up a glove and while holding the glove reset the hemodialysis machine of the patient. The registered nurse did not don the glove used to reset the patient’s contaminated hemodialysis machine. After resetting the patient’s contaminated hemodialysis machine. The registered nurse walked over to Patient #15 who was sitting at station # 21 holding his vascular access. The patient requested bathroom privilege; the registered nurse did not wash/ sanitize his ungloved hand. Registered Nurse (B) walked over to the patient, examined his vascular access with his contaminated hands and accompanied the patient to the bathroom. The Surveyor immediately notified him that he did not don the glove while resetting the patient’s hemodialysis machine and did not wash/ sanitize his hands after resetting the machine. Registered Nurse (B) states” I am sorry I won’t do that again. “ Patient #2 Patient Care Technician (E) On 07/29/2024 at 10:40 a.m. Patient Care Technician (E) was observed at station #5. The patient care technician was terminating the hemodialysis treatment of the patient. Observation revealed after terminating the patient’s hemodialysis treatment, the patient was observed holding her vascular access site with a gloved hand. After holding her vascular access site, the patient removed her contaminated glove, picked up her bag and walker, pushed the walker to the scale accompanied by Patient Care Technician ( E ) and left the unit. The patient care technician did not encourage the patient to wash/ sanitize her contaminated hand used to hold her vascular access site. The Surveyor notified Patient Care Technician( E) that she did not encourage the patient to wash/ sanitize her hands after holding her vascular access site. Patient Care Technician ( E) states “ I did not see her wash her hands.””