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 852550 (X3) Date Survey Completed 10/29/2019
Name of Provider or Supplier Dublin Kidney Institute Street Address, City, State 207 Industrial Blvd Ste 2, Dublin, 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)
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 observation, staff interviews, a review of the Center for Disease Control and Prevention (CDC) recommendations, the facility's Policies and Procedures (P&P), and review of facility records, it was determined that the Infection Control Committee failed to ensure that two of three Patient Care Staff (RN BB and LPN AA), changed gloves and performed hand hygiene when going from a "dirty" task to a "clean" task, to prevent cross contamination. These breaches in infection control techniques could negatively affect the health and safety of two of two patients (P#2 and P#3) who dialyzed at the Skilled Nursing Facility (SNF). Findings include: During observation in the dialysis treatment room at the SNF on 10/29/19 between 11:10 a.m. and 12:45 p.m., the following was revealed: - RN BB did not change gloves and did not perform hand hygiene after flushing P#2's dialysis bloodlines ("dirty" task). While she wore the same contaminated gloves, RN BB checked P#2's temperature, then wrote on P#2's hard copy chart ("clean" task/item). - LPN AA donned a pair of gloves that was at P#2's bedside table (considered "dirty" area). Then LPN AA went to the clean supply area to get more gloves from the glove box. LPN AA also checked P#2's blood pressure (BP), and without removing contaminated gloves, LPN AA went to the clean supply area and took several pieces of clean gauze. - During interviews with LPN AA and RN BB on 10/29/19 between 12:35 p.m. and 12:40 p.m., both stated that they forgot to change their gloves and wash or sanitize their hands. These breaches in infection control techniques could potentially cause the spread of infection-causing pathogens through cross contamination. A review of CDC recommendations stated the following: - Hand hygiene is necessary after glove removal because hands can become contaminated through small defects in gloves and from the outer surface of gloves during glove removal. - Remove gloves and perform hand hygiene between each patient or station, and if moving from contaminated to clean area or task. A review of the facility's P & P titled, "Infection Control Manual" with an effective date of 09/2017 stated: ... to prevent cross-contamination, hands should be washed: a. Upon leaving the patient area b. Upon entering the patient area c. Before any medical aseptic procedure is done d. Before and after each patient contact 4. Examples of when fresh pair of gloves must be put on... When going from "dirty" area or task to a "clean" area or task... A review of the Department of Health's investigation result on 8/6/19 revealed that handwashing/hand hygiene was one of the infection control breaches that was identified during their investigation. There were no records regarding the facility conducting in-services about hand hygiene and glove use and changes. There were no records of the facility's observations and audits of RN AA, RN BB, AND LPN AA, to verify that these Patient Care Staff followed facility P & P regarding hand hygiene and glove changes. During an interview with the Facility Administrator on 10/29/19 at 12:45 p.m., she stated that she observed these same breaches in infection control also, and stated that staff should practice infection control techniques such as hand hygiene between glove changes and when going from dirty area/task to clean area/task.