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 852553 (X3) Date Survey Completed 06/13/2019
Name of Provider or Supplier Flint River Dialysis Street Address, City, State 700 Gordon Avenue, Bainbridge, 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, a review of Centers for Disease Control and Prevention (CDC) guidelines and facility's policy and procedure, and staff interviews, it was determined that the Infection Control Committee failed to ensure that the facility followed appropriate infection control measures, to prevent cross contamination and the spread of infection. This deficient practice had the potential to negatively affect the health and safety of all 60 in-center hemodialysis (ICHD) patients who dialyze at this facility. Findings include: - During a tour of the facility with the Facility Administrator on 6/11/19 between 10:30 a.m. and 1:00 p.m., the following was revealed: There were dried blood splatters of different sizes and shapes approximately 1 cm - 2 cm in diameter on the walls between stations (S) S3 & S4, S6 & S7, S7 & S8, S12 & S13, S13 & S14, and S16 & S17. - During observation in the treatment room on 6/12/19 between 9:30 a.m. and 10:30 a.m., the following was observed: Licensed Practical Nurse (LPN) CC, LPN DD and Patient Care Technician (PCT) BB were observed using Phoenix Meter [a device used to measure pH (acidity) and conductivity (ability of the dialysate to conduct electricity)] at S5, S14, and S8 respectively. They all returned the Phoenix Meters to a common clean area without cleaning and disinfecting after each use to prevent cross contamination. According to CDC, failures 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 patient chair or bed surfaces, dialysis equipment surfaces, adjacent tables and work surfaces) must be performed between patients uses to prevent transmission of dangerous pathogens. A review of the P & P #1-05-10 titled "Infection Control for Dialysis Facilities" stated: 50. 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. 43. Items taken into the dialysis station will be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before taken to a common clean area or used on another patient. 77. Any areas contaminated with visible blood or bloody fluids are cleaned promptly with a well wrung out wipe using 1:10 (one to ten) bleach solution. During an interview with the Facility Administrator (FA) and the Clinical Service Specialist (CSS) on 6/13/19 at 3:25 p.m., FA stated that all staff had been trained in infection control and the P & P should be implemented.