Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 012306 (X3) Date Survey Completed 06/24/2021
Name of Provider or Supplier Childrens Hospital Of Alabama Esrd Street Address, City, State 1600 7th Avenue South, Birmingham, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
V0122 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:
Based on observation, review of facility policy and procedure and interview, it was determined staff failed to follow its own procedure and disinfect all surfaces at the dialysis station. This affected 1 of 2 observations of cleaning the dialysis station and had the potential to affect all patients who dialyzed at the facility. Findings include: Department Policy No. 18640-Infection Control of Dialysis Equipment Department: Renal Care Center Last Revised/Reviewed: 11/20/19 I. Purpose ...to provide current infection prevention and control guidelines regarding cleaning and disinfecting...equipment...to prevent cross-contamination between patients and care-providers. VII. Procedure A. Each dialysis station is cleaned and disinfected prior to each patient's use...includes...not limited to...chair fully reclined, tables, TV...dialysis machine... During observations of cleaning/disinfection at station 7 on 6/22/21 at 3:55 PM, Employee Identifier (EI) # 8 , Unit Support Staff, failed to disinfect the Hansen dialysate hoses on the hemodialysis machine. EI # 8 failed to disinfect the treatment chair surface underneath the right side tabletop. In an interview on 6/24/21 at 11:00 AM, EI #1, Dialysis Coordinator confirmed both surfaces were to be disinfected after the station was vacated.