Volume 2024 | No. 2
SURVEYOR
RENAL DIALYSIS
RD7-E Overview of the requirement:
RD7-C Overview of the requirement:
The organization must achieve standards set by AAMI for water and dialysate quality. Note: This standard is only applicable to in-center dialysis. Compliance is assessed through review of written policies and procedures, monitoring and testing records, response to interview, and observation. Most deficiencies noted inconsistency between AAMI requirements or the organization’s policies and actual practice.
The organization provides infection control training specific to hemodialysis units that enables personnel to demonstrate competence and compliance with infection control principles. It also educates patients and caregivers to report signs and symptoms of infection to healthcare personnel. Written policies and procedures, personnel files, medical records, direct observation and response to interview are used to assess compliance with the standard. Most instances of non-compliance noted a failure to follow organizational policies for preventing catheter-related infection.
Comment on deficiencies:
Comment on deficiencies:
Frequency of citation:
32%
Frequency of citation:
26%
Examples of surveyor findings:
n Electronic logs for documenting chlorine/chloramine checks showed that the facility failed to ensure all checks are performed prior to each patient’s treatment initiation. n Although all pipes, valves and tanks are labeled, the facility did not have a schematic diagram posted that provides a convenient means of identifying pipe content and flow components for valves, sample ports, and flow direction. n Operators do not follow the manufacturer’s instructions regarding dialysate conductivity. The pH must be measured with an independent meter prior to each patient treatment and at any time there is a change in the concentrate (dialysate.) The facility documents the conductivity prior to each patient’s treatment, but there is no evidence of pH being measured. n The softener brine tank requires daily monitoring to ensure a saturated salt solution with salt pellets filling the tank to the level of at least one half full. The brine tank was only filled one fourth of the way with salt pellets. n Ensure testing for free chlorine, chloramine, or total chlorine is performed at the beginning of each treatment day prior to patients initiating treatment and again prior to the beginning of each patient shift. If there are no set patient shifts, testing should be performed approximately every four hours. n When ultrafilters are used in a water purification system for hemodialysis applications, the pressure drop across the ultrafilter (PSI) should be measured using simple inlet and outlet pressure gauges. Ultrafilters operated in the cross- flow mode should also be monitored in terms of the flow rate of water being directed to drain (concentrate.) Results of pressure measurements and bacteria and endotoxin levels are recorded in a log. n Educate staff on water and dialysate requirements. Audits to ensure compliance. n Monitor the softener brine tank daily to ensure that a saturated salt solution exists. Salt pellets should fill at least half the tank. Salt designated as rock salt should not be used for softener regeneration since it is not refined and typically contains sediments and other impurities that may damage O-rings and pistons and clog orifices in the softener control head.
Examples of surveyor findings:
n Facility policy describes appropriate technique when performing catheter and catheter-site care which includes cleaning the hub with a 15 second scrub whenever the TEGO connector is removed from the CVC. Each time a staff member was observed removing the TEGO caps and scrubbing the hub it was for less than 10 seconds. n Personnel records did not show evidence of training and education in infection control practices appropriate to the responsibilities and task assignments of the staff at the time of hire and at least annually thereafter. n There was no specific training and education for practices regarding the appropriate infection control measures to prevent intravascular catheter- related infections, nor was there evidence of an assessment for knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters for home hemodialysis patients. n During a CVC dressing change, a staff member answered a machine alarm during the process of cleaning the access site. The staff member did not remove the dirty gloves, wash hands or don new gloves, after touching the machine, but instead resumed cleaning the catheter site and applying the clean dressing while wearing the same gloves. n Monitor all personnel for demonstrated compliance with infection control practices while providing care and services to patients in the dialysis facility. n Review policies and procedures for catheter and catheter-site care to ensure they: ٝ Define appropriate cleaning/disinfections of the caps used to close the catheter between uses. Require patient/patient care giver education on signs and symptoms that should be reported.
Tips for compliance:
Tips for compliance:
achc.org | (855) 937-2242 | 15
14
Made with FlippingBook interactive PDF creator