Davita Wheeling 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: 42792 Based on observations, document review and staff interview, the facility failed to ensure that a infection control was maintained in the station treatment area. This failure has the potential to transmit infection diseases. This can adversely affect all Patients receiving dialysis treatment in this facility. Findings Include: An undated policy titled: “Infection Control for Dialysis Facility” provided by the facility stated, in part, “Hand Hygiene: 1. All teammates ... will perform hand hygiene: A. upon entering and exiting the Patient treatment area, b. prior to gloving and immediately after removal of gloves ... d. after Patient and dialysis deliver system contact ... g. before touching clean area areas such as supplies, supply cart and chairside keyboard/mouse ... 3. Use of an alcohol-based hand rub may be substituted for handwashing ... Hand washing will be performed if hands are ... caring for Patients ... A document review was conducted on the policy title, “Termination of Dialysis utilizing b Braun Dialog+ Dialysis Delivery Systems with All Single Use Dialyzer Types and Streamline Blood Lines” dated: October 23, 2023. The policy states, Procedure: 1. Gather supplies. Perform hand hygiene. Put on Personal Protective Equipment [PPE]. 2. Obtain and document vital signs. 3. Verify barrier is under access connections. 4. Obtain post labs as ordered. Verify that all medication has been administered. 5.If the sterility cap is not in place on the saline infusion line Lock Site: it must be disinfected prior to use by: a. Placing an alcohol prep pad over the opening on the saline infusion line Lock Site; Inserting the cap probe into the saline infusion line Lock Site, pushing the alcohol prep pad down firmly into the saline infusion line Lock Site socket: c. Pressing firmly and rotating for thirty [30] seconds: d. Removing cap probe and discarding alcohol prep pad. 6. Press the END TREATMENT. ICON: Press confirm. Blood pump will stop, and the blood flow rate will change to the default pre-programmed rate. 7. Close clamps on arterial access and blood line. Aseptically disconnect arterial blood line from arterial access connection. Attach saline filled syringe to arterial access. 8. Attach arterial blood line to saline infusion line Lock Site. 9. Open the upper clamp on IV administration set and verify that the lower clamp is closed. Open arterial blood line clamp. Reinfusion screen will appear. Press “confirm”. 10. Turn blood pump on to two hundred [200] milliliter/ minute [ml/min], dialysis delivery system will automatically infuse saline until no red blood cells are detected at the venous line air detector OR venous volume reaches 400 ml OR rinse back time a reach five [5] minutes. Verify that the Lock Site connection is secure, so no air is drawn into the system. Refer to physician order for a pediatric Patient. If additional saline is necessary, the blood pump can be turned on by pressing the blood pump Start/Stop button and administering the required amount of saline. 11. Flush arterial access with saline filled syringe during rinse back. 13. Check Patient’s blood pressure [BP]. If stable, press cancel to exit reinfusion screen. If hypotensive, restore BP by infusing additional saline. 14. Disconnect venous blood line from the venous access. 15. Discard gloves, perform hand hygiene and put on new gloves. Perform post dialysis access care per procedure. 17. Remove blood lines and dialyzer per manufacturer’s recommendation and discard in biohazardous waste container. 18. Press Disinfection icon: ... An observation on 7/2/24 at 12:30 p.m. of Employee #1 attempting to disconnect Patient #10 from a dialysis machine, revealed that Employee #1 only sanitized hands one (1) time and put on one (1) pair of gloves during the whole process of removing a Patient from the blood lines and removing the dialysis needles from the Patient arm. During this process the Employee #1 continued to adjust (his/her) shield on their head and touching (his/her) lab coat. The only time (he/she) removed gloves and hand sanitized was when the process was completed and then helped Patient out of the chair. An interview was conducted on 07/02/24 at 2:00 p.m. with the Employee #2 regarding the hand sanitizing and gloves changes during the disconnection of a Patient from the dialysis machine. Employee #2 stated, “When disconnecting a Patient from the dialysis machine the PCT should be sanitizing and changing gloves at least six (6) times. If a PCT is only sanitizing hands and putting only one (1) pair of disposal gloves when disconnecting a Patient from the bloodlines this is not the appropriate hand hygiene methods.””

“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: 42792 Based on observations, document review and staff interview, the facility failed to ensure a sanitary environment when cleaning a dialysis station. This failure has the potential to have an adverse effect fo all patients who receive care in the facility. Findings Includes: An undated policy titled: “Infection Control for Dialysis Facility” provided by the facility stated, in part: “Hand Hygiene: 1. All teammates ... will perform hand hygiene ... c. after contamination with blood or other infectious material ... Disinfection 12. Cleaning and/or disinfection of equipment and work surfaces will be performed as soon as possible following exposure to blood or other potentially infectious material ... and prior to returning to clean/designed area or removal from treatment area ... a. Prior to routine disinfection, remove all visible blood. i. for visible blood or gross blood spills, 1:10 [one to ten] bleach solution must be utilized. ii. After all visible blood is cleaned with the 1:10 [one to ten] bleach solution teammates are to use a new disposable towel soaked with 1:10 [one to ten] bleach solution and clean area a second time. 13. At the end of each treatment, the dialysis station will be cleaned and disinfected. A. Surface to disinfect include but are not necessarily limited to all surface in contact with the Patient ... (e.g. dialysis chair, tray tables, blood pressure cuffs) and frequently contacted by healthcare personnel (e.g., control panel, top, front and sides of dialysis machine; touchscreens; countertops) i. The wall box, drain and water supply lines are considered part of the dialysis delivery system ... An observation on 7/1/24 at 2:10 p.m. of Employee #1, revealed that Employee #1 used soaked wipes to clean up the visible blood spill on the floor near the dialysis machine. When Employee #1 completed cleaning up the blood spill (he/she) removed the disposal gloves and placed them in the trash can near the dialysis machine along with the disposable wipes which he/she cleaned the floor with. The Employee #1 did not perform any hand hygiene before putting on a new pair of disposal gloves. The Employee #1 started to disinfect the dialysis machine from the bottom to the top of the machine. With the same soaked disposal wipes were used to clean the dialysis machine and the Patient chair. When the Employee #1 was done disinfecting the Patient chair the Employee #1 went back to the dialysis machine and continued to wipe off the machine in areas that (he/she) felt they might have missed the first time disinfecting the machine. At no time did the Employee #1 do any hand hygiene or change gloves between the two (2) surface areas or discarding the wipes for new wipes to disinfect the different surfaces. An interview was conducted on 07/01/24 at 3:35 p.m. with the Employee #2 regarding the process for disinfecting stations and cleaning up blood spills. They stated, “Blood is to be wiped up with 1/10 [one to ten] beach solution for the first attempt to clean the area. Then the staff is to wipe the area again with 1/100 [one to one hundred] beach solution. After this process the staff is to change their gloves and do hand sanitize before putting on a new pair of gloves to finish the cleaning process. The staff would start cleaning the dialysis machine from the top to the bottom of the machine. The staff are to change their gloves and hand sanitize before starting to disinfect the Patient chair. Once the chair is completely disinfected the staff would once again remove their gloves and hand sanitize once again before the staff is to clean the wall boxes. After the wall boxes were cleaned the staff would once do hand sanitize process again.””