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 012502 (X3) Date Survey Completed 01/08/2020
Name of Provider or Supplier Tuscaloosa University Dialysis Street Address, City, State 220 15th Street, Tuscaloosa, 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 3 of 3 observations of cleaning and disinfection of the hemodialysis stations, review of facility policy, Centers for Disease Control and Prevention (CDC) Checklist: Dialysis Station Routine Disinfection, and interviews 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 2019 Purpose: To minimize the spread of infection or bloodborne pathogens in the dialysis facility environment. Facility Hygiene 44. 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 appropriate disinfectant after every treatment... 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...IV (Intravenous) poles, as well as work surfaces will be wiped clean with a 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 the blood pressure cuff, the inside and outside of the prime container, hemostats (blood line clamps), and the dialysis delivery systems, with an appropriate disinfectant after each treatment. CDC Checklist: Dialysis Station Routine Disinfection Part A: Before Beginning Routine Disinfection of the Dialysis Station Disconnect and takedown used blood tubing and dialyzer from the dialysis machine. Discard tubing and dialyzers in a leak-proof container Before Beginning Routine Disinfection of the Dialysis Station Disconnect and takedown used blood tubing and dialyzer from the dialysis machine. ...Discard all single-use supplies. Move any reusable supplies to an area where they will be cleaned and disinfected before being stored or returned to a dialysis station. 1. During observations of care on 1/6/2020 at 10:50 AM the surveyor observed Employee Identifier (EI) # 2, Certified Clinical Hemodialysis Technician (CCHT), clean and disinfect dialysis station 15. EI # 2 failed to clean the entire dialysis machine to include the IV pole, hemostat, purple pouch, and clipboard. Further observation revealed EI # 2 failed to clean and disinfect underneath the chairside table tops and the exterior chair panels bilaterally. An interview was conducted with EI # 2 on 1/8/2020 at 12:07 PM who verified he/she failed to perform cleaning and disinfection of the dailysis station per policy. 39098 2. During observations of care on 1/6/2020 at 1:15 PM the surveyor observed EI # 8, CCHT, cleaning and disinfecting dialysis station # 10. EI # 8 cleaned the chair, then removed the blood lines from the dialysis machine. EI # 8 failed to remove all patient supplies from the dialysis station before starting the disinfection process. An interview was conducted on 1/8/2020 at 11:18 AM with EI # 8, who confirmed she/he did not follow the recommended guidelines for cleaning the dialysis station. 3. On 1/6/2020 at 2:00 PM the surveyor observed EI # 6, CCHT, cleaning and disinfecting station # 1. EI # 6 failed to clean the entire dialysis machine to include the IV pole, hemostat, purple pouch, and clipboard. An interview was conducted on 1/8/2020 at 10:38 AM with EI # 6, who confirmed she/he failed to clean the entire dialysis machine per policy.