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 012509 (X3) Date Survey Completed 03/30/2023
Name of Provider or Supplier North Alabama Nephrology Center Street Address, City, State 1311 North Memorial Parkway #200, Huntsville, 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)
V0130 IC-HBV-ISOLATION-MACHINES/EQUIP/SUPPLIES
CFR(s): 494.30(a)(1)(i)

Isolation of HBV+ Patients To isolate HBsAg positive patients, ... dedicate machines, equipment, instruments, supplies, and medications that will not be used by HBV susceptible patients.


This STANDARD is not met as evidenced by:
Based on observation, review of facility policy, and interviews, it was determined the facility failed to ensure all equipment used in the isolation room was designated and labeled for "isolation" only. This had the potential to affect all Hepatitis B susceptible patients and staff at the facility. Findings include: Facility Policy: Dialyzing Patients with Positive Hepatitis B Antigen (HBsAg+) Published 3/20/13 Policy Number: None Version: Seven Purpose: To prevent transmission of Hepatitis B Equipment and Supplies: Separated dedicated supplies and equipment...must be used to provide care to the HBsAG positive patient: All supplies used in the isolation room/area such as clamps, blood pressure cuffs, testing reagents, etc., should be labeled "isolation" and not routinely removed. 1. On 3/28/23 at 9:20 AM observations were conducted with EI (Employee Identifier) # 2, RN (Registered Nurse), facility Charge Nurse, in the isolation room during inspection of the equipment/supplies housed in the isolation unit. There was no isolation label on the following equipment/supplies: Patient treatment chair One HD (Hemodialysis) machine # (number) 22 One container for 1 to 100 bleach concentration One gallon size container of Pure Bright bleach One Rolling Sharps container One Rolling Bio-hazard box One Treatment stool In an interview conducted on 3/28/23 at 9:29 AM, EI # 2 confirmed all equipment and supplies in the isolation room were not labeled and designated for isolation only use.