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 012501 (X3) Date Survey Completed 06/30/2021
Name of Provider or Supplier Gadsden Dialysis Street Address, City, State 409 South First Street, Gadsden, 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 1 of 2 observations of cleaning and disinfection of the hemodialysis stations, review of facility policy and interview, it was determined the facility failed to ensure staff cleaned and disinfected the dialysis station after patient treatments. This had the potential to negatively affect all patients in this facility. Findings Include: Policy: Infection Control for Dialysis Facility Policy Number: 1-05-01 Revision Date: October 2020 Purpose: To minimize the spread of infection or bloodborne pathogens in the dialysis facility environment. Facility Hygiene ...46. Equipment including the dialysis delivery system, the interior and exterior of the prime container, the dialysis chair and side tables including opening the chair to reach crevices, blood pressure equipment, television arms and control knobs or remote control devices if accessible to patient and teammates...as well as work surfaces will be wiped clean with bleach solution of the appropriate strength...before being used on another patient ..., and after each treatment. Dialysis Station Management ...66. Teammates will thoroughly wipe down all non-disposable items and equipment such as the blood pressure cuff, the inside and outside of the prime container, ... and the dialysis delivery systems, with an appropriate disinfectant after every treatment... 1. During observations of care on 6/28/21 at 8:40 AM the surveyor observed Employee Identifier (EI) # 6, Certified Clinical Hemodialysis Technician, clean and disinfect dialysis station 20. EI # 6 failed to clean and disinfect the dialysate hoses and Hansen connectors on the side of the dialysis machine as directed per the facility policy. An interview was conducted on 6/30/21 at 11:50 AM with EI # 1, Facility Administrator, who verified the staff failed to follow the facility policy for cleaning and disinfection after patient treatments.