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 852540 (X3) Date Survey Completed 01/06/2023
Name of Provider or Supplier Camilla Dialysis Street Address, City, State 251 Us 19 N, Camilla, GA
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 observation, staff interview, a review of Centers for Disease Control and Prevention (CDC) guidelines, and a review of the facility's policies and procedures (P & P), it was determined that the facility failed to ensure that one of one Registered Nurse (RN AA), one of one Licensed Practical Nurse (LPN AA), and four of four Patient Care Technicians (PCTs AA, BB, CC, and DD), who were present during this observation, immediately and thoroughly cleaned and disinfected five of five blood-contaminated surfaces on the cover of sharps containers observed, between patient use. This failure could lead to the transmission of dangerous pathogens through cross contamination. This deficient practice had the potential to negatively affect the health and safety of 20 hemodialysis patients (P#8 - P#27), who were undergoing hemodialysis treatment at the time of this observation. The facility census was 74. Findings include: During observation in the patients' treatment room on 1/4/23 between 1:45.m. and 2:45 p.m., the following was observed: There were blood splatters of different shapes and sizes on the covers of the sharps containers between Stations (S) 2 and S3, between S6 and S7, at S9, next to the document shredder, right under the fire extinguisher, between S13 and S14 and between S15 and S16. The Charge Nurse (RN AA) confirmed and acknowledged these observations and stated on 1/4/23 at approximately 2:45 p.m., that the dried blood should have been disinfected right away. According to CDC guidelines, failure in environmental cleaning and disinfection have led to transmission of bloodborne pathogens (e.g., Hepatitis B virus) and other infections from one patient to another in hemodialysis units. Correct cleaning and disinfection of environmental surfaces (including floors, patient chair or bed surfaces, dialysis equipment surfaces, adjacent tables and work surfaces, etc., especially with blood splatters) must be performed between patient uses to prevent transmission of dangerous pathogens. A review of facility Policy: 1-05-01, titled, "Infection Control for Dialysis Facilities", with latest revision date of October 2022, stated: 45. Cleaning and/or disinfection of equipment and work surfaces will be performed as soon as possible following exposure to blood or other potentially infectious materials ... After all visible blood is cleaned with the 1:10 (one to ten) bleach solution, teammates are to use a new disposable towel soaked with 1:10 (one to ten) bleach solution and clean area a second time.