Fresenius Medical Care Braxton County

“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: 32177 Based on observation, document review and staff interview it was determined nursing failed to perform proper hand hygiene in accordance with the Centers for Disease Control and Prevention (CDC) guidelines and facility policies and procedures. This failure was observed in four (4) out of ten (10) initiation and termination of dialysis (patients #1, 3, 4 and 9). This failure has the potential to place all patients at risk for infection. Findings include: An observation was conducted at station #1 on 12/04/23 at approximately 8:45 a.m. with Patient Care Technician (PCT) #1 and patient #4. No handwashing/sanitizing was completed prior to gloving. An observation was conducted at station #2 on 12/04/23 at approximately 9:25 a.m. with PCT #1 and patient #3. PCT #1 failed to clean their hands or change their gloves from the beginning of discontinuing dialysis until dialysis completely discontinued. An observation was conducted at station #4 on 12/04/23 at 9:40 a.m. with PCT #2 and patient #1. PCT #2 failed to clean their hands or change their gloves from the beginning of discontinuing dialysis until dialysis completely discontinued. An observation was conducted at station #5 on 12/04/23 at 9:45 a.m. with Registered Nurse (RN) #1 and patient #9. RN #1 failed to change gloves after touching electrical outlet prior to connecting Vancomycin 100 milligrams to dialysis. A review of facility policy, titled “Hand Hygiene,” published 11/06/23, states in part: “Hands will be ... decontaminated using alcohol-based hand rub or by washing hands with antimicrobial soap and water, Before and after direct contact with patients, Entering and leaving the treatment area, Before performing any invasive procedure such as vascular access cannulation or administration of parenteral medications, Immediately after removing gloves, After contact with body fluids or excretion, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled, After contact with inanimate objects near the patient, When moving from a contaminated body site to a clean body site of the same patient, After contact with the dialysis wall box, concentrate, drain or water lines.” A review of CDC guidelines, titled “Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients,” dated 04/27/01, states in part: “Hands always should be washed after gloves are removed and between patient contacts, as well as after touching blood, body fluids, secretions, excretions, and contaminated items.” An interview was conducted with the Clinical Manager on 12/04/23 at approximately 10:30 a.m. They concurred hands should be cleaned, and new gloves used.”

“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: 32177 Based on observation, document review and staff interview it was determined the staff failed to follow their policy on cleaning dialysis machines after completion of dialysis in two (2) of ten (10) observations (patient #2). This failure has the potential to place all patients at risk for infection via cross-contamination. Findings include: An observation was conducted on 12/4/23 at 9:20 a.m. at station #3 with Patient Care Technician (PCT) #2. Upon completion of patient #2’s dialysis, PCT #2 removed all bloodlines from the dialysis machine, then cleaned the dialysis machine while patient #2 remained in the chair for post-dialysis monitoring. An observation was conducted on 12/5/23 at 10:30 a.m. at station #5 with Patient Care Technician (PCT) #2. Upon completion of patient #2’s dialysis, PCT #2 removed all bloodlines from the dialysis machine, then cleaned the dialysis machine while patient #2 remained in the chair for post-dialysis monitoring. A review of the policy, titled “Cleaning and Disinfecting the Dialysis Station,” published 09/05/23, states in part: “Vacating the Machine: To prevent cross-contamination between patients, it is important that the previous patient completely vacate the station before staff begin cleaning ...” An interview was conducted with the Clinical Manager on 12/05/23 at approximately 11:30 a.m. They concurred that the machine should not be cleaned while the patient is in the dialysis chair.”

“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: 32177 Based on observation, document review and staff interview, it was determined the facility failed to ensure nursing staff protect patients’ Central Venous Catheter (CVC) hubs from contamination by failing to place a clean barrier under the CVC ports in accordance with facility policy and the Centers for Disease Control and Prevention (CDC) guidelines. This failure was observed in one (1) out of one (1) observation for discontinuation of dialysis for patients with CVC’s (patient #8). This failure has the potential to place all patients at risk for central line infections. Findings include: An observation of initiation of dialysis with a CVC on 12/04/23 at 12:01 p.m. with Patient Care Technician (PCT) #1 revealed PCT #1 was initiating CVC at station #6 on patient #8 and failed to place a barrier under the patient’s ports. A review of CDC protocol, entitled “Hemodialysis Central Venous Catheter Scrub-the-Hub Protocol,” revealed it states in part: “Aseptic Technique. This includes practices that prevent the contamination of clean/sterile items and surfaces. Once tasks requiring aseptic technique have been started, care must be taken to avoid contamination of gloves and other clean/sterile items that can occur when touching dirty surfaces.” A review of the policy, titled “Initiation of Treatment Using a Central Venous Catheter,” published 07/06/21, states in part: “Follow the steps below to prepare for the termination of dialysis: ... Place an under pad under the access limbs to protect the work area and the patient’s clothing.” An interview was conducted with the Clinical Manager on 12/04/23 at approximately 1:00 p.m. and they concurred a clean barrier should be used under CVC port during initiation of dialysis.”