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 012505 (X3) Date Survey Completed 07/26/2018
Name of Provider or Supplier Physicians Choice Dialysis-Montgomery Street Address, City, State 1001 Forest Avenue, Montgomery, 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)
V0113 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:
Based on observations, facility policies and procedure for hand hygiene, the CMS (Centers for Medicare and Medicaid Services) ESRD (End Stage Renal Disease) Core Survey Hemodialysis Care and Infection Control Practices Worksheet and staff interview, it was determined the facility failed to ensure staff performed hand hygiene according to the facility policy and the CMS ESRD Core survey infection control worksheet requirements. This affected Patient Identifier (PI) # 4, which was 1 of 3 access cannulation's observed and this had the potential to negatively affect all patients who dialyzed at the facility. Findings include: Title: Infection Control for Dialysis Facilities Policy: 1-05-01 Revision Date: April 2018 "Purpose To minimize the spread of infections or bloodborne pathogens in the dialysis facility environment... Teammate Hygiene 1. Hand hygiene is to be performed upon entering the patient treatment area, prior to gloving, after removal of gloves, after contamination with blood or other infectious material, after patient and dialysis delivery system contact, between patients even if the contact is casual, before touching clean areas such as supplies and on exiting the patient treatment area... Teammate / Patient Safety 11. Teammates will wear disposable gloves when caring for the patient or touching the patient's equipment at the dialysis station, and will remove gloves and wash hands or perform hand hygiene between each patient and/or station... Title: Handwashing Procedure: 1-05-01B Revision Date: September 2016 Materials required: Antibacterial liquid soap Water Paper towels ...3. Cover hands...and wrists with later and wash vigorously... 4. Rinse well... 5. Dry hands thoroughly with paper towels. 6. If sink is not pedal operated operated, turn faucet off with elbows or paper towels..." CMS Core Survey Worksheet Version 1.5 Access of AV (arteriovenous) or Graft for Initiation of Dialysis ...Action ...Evaluate access: Locate/palpate cannulation site Hand Hygiene (remove gloves if worn); don clean gloves... **** During observations of care on 7/24/18 at 12:00 PM, Employee Identifier (EI) # 6, Certified Clinical Hemodialysis Technician (CCHT) evaluated the access site using the stethoscope, then completed access site antisepsis and cannulation. EI # 6 failed to remove gloves and perform hand hygiene after access site evaluation. During observations of care conducted on 7/25/18 at 11:50 AM, EI # 4, CCHT performed hand hygiene at the clean sink across from station 2. EI # 4 turned the faucet off with bare hands. An interview was conducted on 7/26/18 at 12:00 PM with EI # 1, Facility Administrator, who verified EI # 5 failed to follow the facility hand hygiene policy and procedure.