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 012513 (X3) Date Survey Completed 07/14/2021
Name of Provider or Supplier Bma Langdale Street Address, City, State 8 Medical Park North, Valley, 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 observations, review of facility policy and interview, it was determined the facility failed to ensure: 1. All equipment used in the isolation room was designated and labeled for "isolation" only. 2. Infectious Waste in red bag was removed from the HBsAg (Hepatitis B surface Antigen) positive patient care room/area each day. This had the potential to negatively affect all Hepatitis B susceptible patients, visitors, and facility staff. Findings include: Policy: Dialyzing Patients with Positive Hepatitis B Antigen Published: 3/20/13 Version: 7 Purpose: To prevent the transmission of Hepatitis B. Policy: ...all patients with hepatitis B infection treated in the dialysis facility require additional infection control precautions... Isolation of Hepatitis B virus positive (HBsAg+) patients. All patients who are HBsAg positive must dialyze under isolation precautions. 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. (etcetera), should be labeled "isolation" and not routinely removed... All disposable items, including the patient's dialyzer, shall be considered infectious, and shall be red-bagged, labeled as Infectious Waste and removed from the HBsAg positive patient care room/area each day using Standard Precautions. 1. On 7/12/21 at 11:30 AM CST (Central Standard Time) the surveyor toured the isolation room with Employee Identifier (EI) # 10, Certified Clinical Hemodialysis Technician (CCHT). The following items were in the isolation room and not labeled "isolation": 1 pHoenix meter. 1 plastic container with white lid labeled 1:100 bleach solution. 4 gallons of vinegar. 2 gallons of bleach. 2. On 7/13/21 at 5:00 PM CST, the surveyors again toured the isolation room and observed the red-bagged hazardous waste trash was full and contained dialyzers and blood lines used from the 7/12/21 treatment day. During an interview conducted on 7/14/21 at 11:25 AM CST, EI # 1, Director of Operations, confirmed the equipment should have been labeled "isolation" and the red-bagged hazardous waste should have been emptied on 7/12/21.