CMS SOM App. H, Tag V405

(i) Maintain a comfortable temperature within the facility; and

(ii) Make reasonable accommodations for the patients who are not comfortable at this

temperature.

Interpretive Guidance §494.60(c)(2)

The facility must make reasonable efforts to provide a comfortable environment for patients and

staff, in spite of conflicting perceptions of “comfortable.”

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It is not uncommon for patients to feel cold during their dialysis treatments, and there are many

reasons that some patients experience feeling uncomfortable in the facility. Some reasons for

feeling cold include:

• Anemia: many patients with chronic kidney disease do not produce enough red blood

cells which circulate and carry oxygen throughout the body. This leads to patients feeling

cold and tired;

• Skin exposure, if the patient has a graft or fistula;

• Remaining seated for 3-4 hours during treatment with limited ability to move around;

and

• Blood temperature: during dialysis, blood is circulated outside of the body, sent through

the dialyzer to filter wastes and toxins and then returned back to the patient which may

lead to some patients feeling uncomfortable and cold.

Dialysis facility staff tend to experience more warmth than patients due to the PPE that is worn

and staying active for extended periods of time to perform their duties, which may affect their

perception of what constitutes a comfortable temperature. Dialysis facility staff should take

measures to ensure temperatures within the facility are maintained at a comfortable level. Unlike

operating rooms, which are required to maintain cooler air temperatures, dialysis facilities may

use the standard temperature range of 70°F–75°F (21°C–24°C) to achieve a greater degree of

patient and staff comfort (CDC guidance for Environmental Infection Control in Health-Care

Facilities).

The dialysis facility must make attempts to address any causal factors that lead to a patient

feeling uncomfortable with the room temperature set by the dialysis unit. For example,

“reasonable accommodations” would include offering hats, blankets, or other warming devices.

Patients that are seated near vents or windows may also experience feeling cold or

uncomfortable and may need to be moved to another area of the room. When cold, some patients

find it helpful to use a glove for the hand on their access arm, others find wearing a cap helpful.

§ 494.60(c)(4) requires the patient to be in view of staff during hemodialysis treatments to ensure

patient safety. This includes direct visualization of their vascular access site to assess for

patency and appropriate connections, e.g. central venous catheter site or an AV fistula/graft. If

patients choose to use a blanket or other covering, their vascular access site, bloodline

connections, and face must be visible throughout the treatment. A head covering on a patient is

acceptable, as are gloves. If there are concerns for patient or vascular access site visualization

during hemodialysis treatments, refer to V407.