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 02/27/2025
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)
V0116 IC-IF TO STATION=DISP/DEDICATE OR DISINFECT
CFR(s): 494.30(a)(1)(i)

Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient's station should be used only for that patient and should not be returned to a common clean area or used on other patients.


This STANDARD is not met as evidenced by:
Based on review of facility policy, observations, and staff interview, it was determined the facility failed to ensure the Phoenix XL Meter (used for testing the pH and conductivity of the dialysate) was disinfected after each use per facility policy. This affected two of two observations of preparation of the hemodialysis machine and extracorporeal circuit and had the potential to negatively affect the 17 incenter patients dialyzing at the facility. Findings include: Facility Policy: Phoenix Meter XL Dialysate Testing Policy Number: 18372 Date Published: Not listed Procedure: The conductivity and pH of dialysate will be checked before every dialysis treatment and before using a different composition of acid concentrate during the same treatment. ...6. Once testing is complete... 7. Clean Phoenix XL meter with appropriate disinfectant wipe. 1. An observation was conducted on 2/25/25 at 11:40 AM with Employee Identifier (EI) # 7, Registered Nurse (RN), preparing the hemodialysis machine at station 5. After checking the pH and conductivity of the dialysate, EI # 7 returned the Phoenix XL meter to the countertop in the common area without wiping the meter with the appropriate disinfectant wipe. An interview was conducted on 2/25/25 at 12:50 PM with EI # 1, Director of Nursing, who confirmed staff failed to clean the Phoenix XL meter with the appropriate disinfectant wipe after use per facility policy. 30952 2. An observation was made on 2/25/25 at 12:27 PM with EI # 1, at station 4, to test the conductivity and pH of the dialysate with the Phoenix XL meter for an unsampled patient. After testing the dialysate, EI # 1 placed the meter on the counter at station 4, and exited the station. EI # 1 failed to disinfect the meter after use per facility policy. An interview was conducted on 2/27/25 at 12:18 PM with EI # 1, who confirmed staff failed to follow the policy and disinfect the Phoenix XL meter after use.