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 852560 (X3) Date Survey Completed 02/22/2024
Name of Provider or Supplier Poplar Dialysis Street Address, City, State 2301 Newnan Crossing Blvd, Ste 180, Newnan, 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, and a review of facility Policy and Centers for Disease Control and Prevention (CDC) Recommendations, it was determined that the Infection Control Committee failed to ensure that one of two Patient Care Technicians (PCT CC) and one of two Registered Nurses (RN BB), observed, performed hand hygiene (washed hands or used an alcohol based hand sanitizer) after removal of contaminated gloves, between glove changes and after touching contaminated equipment. This failure increased the risk for cross contamination with the potential to expose all staff and 52 in-center hemodialysis patients who dialyzed at this facility, to blood borne pathogens in the dialysis environment. Findings were: During observation in the Patient Treatment Room on 2/20/24 between 9:30 a.m. and 12:30 p.m., the following was revealed: - RN BB was observed while providing care for a patient at Station (S) 15. She removed her gloves and did not perform hand hygiene after glove removal and prior to obtaining gauze from the clean supply cart. During observation in the Patient Treatment Room on 2/21/24 between 6:00 a.m. and 12:00 p.m., the following was revealed: - RN BB administered intravenous medication to a patient at S18. When finished, she removed her gloves and did not perform hand hygiene prior to donning a new pair of gloves. - PCT CC provided care for a patient at S1. She left S1 and retrieved a marker from the clean supply cart while she wore contaminated gloves. - PCT CC touched the dialysis machine panel at S2. She removed her gloves and did not perform hand hygiene. - PCT CC donned clean gloves, touched the patient's blanket, adjusted the chair footrest, handed the television remote control to the patient at S3, and then proceeded to initiate patient's dialysis treatment with the same gloves. During an interview with RN BB and Staff CC on 2/21/24 at 7:00 a.m., RN BB stated that she thought she was following the facility policy. A review of Policy: 1-05-01 titled, "Infection Control for Dialysis Facilities" dated April 2023 stated: Hand Hygiene 1. All teammates, Physicians and Non-Physician (NPP) will perform hand hygiene: b. Prior to gloving and immediately after removal of gloves, c. After contamination with blood or other infectious material, d. After patient and dialysis delivery system contact... g. Before touching clean areas such as supplies, supply cart and chairside keyboard/mouse. According to CDC recommendations, even with glove use, 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.