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 852569 (X3) Date Survey Completed 06/23/2023
Name of Provider or Supplier Dialysis Center Of Athens Street Address, City, State 210 Hawthorne Park, Athens, 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)
V0117 IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS
CFR(s): 494.30(a)(1)(i)

Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients.


This STANDARD is not met as evidenced by:
Based on observation, a review of the CDC recommendations, staff interviews, and a review of the facility P & P, it was determined that the Infection Control Committee failed to ensure that three of three Direct Patient Care (DPC) Staff (Registered Nurse - RN AA, and Patient Care Technicians (PCTs AA and BB), who were present during this observation, utilized appropriate infection control techniques to prevent cross contamination. This breach in infection control techniques could negatively affect the health and safety of four of four in-center hemodialysis Patients (P), (P#2, P#3, P#4, and P#5), who were undergoing hemodialysis at the time of this observation and the other nine patients (P#1, P#6, P#7, P#8, P#9, P#10, P#11, P#12, and P#13), who were also under the care of this facility. Findings include: During a tour of the Patient Treatment Room on 6/21/23 at 11:30 a.m., the following was revealed: -There was a ziplock bag full of blood samples in vacutainer blood collection tubes (approximately 10 tubes) in the Medication Refrigerator stored with patients' medications. - PCT AA stated on 6/21/23 at 11:40 a.m. that the new nurse probably didn't know where to put the lab tubes yet. - RN AA (new to the clinic nurse) stated on 6/23/23 at 2:05 p.m. that she did not put the lab tubes in the medication refrigerator. She added that she was shocked to see them there. -According to the CDC, cross contaminating, storing dirty (blood sample tubes) in a clean area such as (Medication Refrigerator that had pre-filled medication syringes and vials), could cause the spread of bacteria/infections.