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Core principles for infection prevention in hemodialysis centers during the COVID-19 pandemic

Published online by Cambridge University Press:  06 April 2020

Gang Chen
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Yangzhong Zhou
Affiliation:
Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Lei Zhang
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Ying Wang
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Rong-rong Hu
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Xue Zhao
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Dan Song
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Jing-hua Xia
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Yan Qin
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Li-meng Chen
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
Xue-mei Li*
Affiliation:
Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking, China
*
Author for correspondence: Xuemei Li MD, E-mail: Lixmpumch@126.com
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Abstract

Type
Letter to the Editor
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

To the Editor—The COVID-19 outbreak began at the end of December 2019, and >600,000 confirmed cases had been reported worldwide by the end of March 2020. The World Health Organization declared a global pandemic.Reference Mahase1 Nosocomial transmission was severe in some locations, and the burden to the health system was extreme.Reference Wang, Hu and Hu2 Hemodialysis centers, which generally serve high volumes of highly mobile dialysis patients, have an exceptionally high risk of exposure during this outbreak period. In a general tertiary-care hospital, dialysis centers routinely accept patients from outpatient clinics and emergency rooms, further adding to the difficulty of preventing nosocomial infection.Reference Karkar, Bouhaha and Dammang3 Dialysis patients, commonly regarded as immune compromised, are likely to develop severe illness as a result of close contact in a medical unit.

Droplet spread and close contact are the main routes of COVID-19 transmission.4 Thus, the hemodialysis center in our hospital implemented multiple strategies for infection prevention, including area management and integrated symptom monitoring, in the context of this pandemic.

Based on various levels of exposure to the mobile population, our hospital environments were classified as low-risk, medium-risk, high-risk, and extremely high-risk, and the dialysis center belongs to the high-risk category. We avoid moving across the area by designing a specific walking route for our patients entering the hemodialysis center. Medical staff wears personal protective equipment (PPE) when inter-area contact is inevitable. For example, N95 masks and protective glasses are required when entering the fever clinic. We advise the use of hand sanitizer whenever staff return to the hemodialysis center. In the dialysis center, a 1-way route is followed by our patients, and mask-wearing and hand sanitizing by the patients are ensured. During the dialysis session, we provide necessary education on maintaining social distancing and self-protection. Between the 2 dialysis shifts, we strictly leave at least 30 minutes for environmental and air disinfection, and we utilize a chlorine-containing disinfectant to clean our dialysis facilities.68

We monitor and respond to our regular patients’ symptoms in an integrated way. Between the dialysis sessions, we strictly record the body temperatures and any suspicious respiratory symptoms of our patients. For patients referred from other departments in the hospital, we collect records of their contact history, temperature, and potential warning symptoms before admission. Based on this information, all of our patients are classified into 3 categories (Table 1). A negative SARS-CoV-2 swab test is needed for patients in category C before their dialysis session can be scheduled. In emergency cases, we perform continuous renal replacement therapy (CRRT) in a separate place, preferably in a negative-pressure ward, before completely ruling out COVID-19 for these patients.5,6 Notably, patients with a positive swab test are sent to designated hospitals for further treatment.

Table 1. High-Risk and Suspicious Patient Identification and Classification Management

Medical staff are strictly required to maintain hand hygiene and to wear a mask at work. N95 masks and protective goggles are used when operating CRRT for patients in category C. The equipment used is disinfected between patients, and medical waste is packed and labeled separately to avoid potential contamination.7 The waste liquid generated during CRRT is discharged according to the requirements of the medical wastewater discharge standards.8

In addition to the strategies summarized above, we promote work–life balance for staff and encourage patients to take the initiative to participate. Our hemodialysis center has strived to achieve zero infection during the ongoing COVID-19 outbreak.

Acknowledgments

The work is made possible through an ISN Sister Renal Center Cooperation.

Financial support

No financial support was provided relevant to this article.

Conflicts of interest

All authors report no conflicts of interest relevant to this article.

References

Mahase, E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction. BMJ 2020;368:m1036.CrossRefGoogle ScholarPubMed
Wang, D, Hu, B, Hu, C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020. doi: 10.1001/jama.2020.1585.Google ScholarPubMed
Karkar, A, Bouhaha, BM, Dammang, ML. Infection control in hemodialysis units: a quick access to essential elements. Saudi J Kidney Dis Transpl 2014;25:496519.CrossRefGoogle ScholarPubMed
Novel coronavirus pneumonia diagnosis and treatment plan (provisional 7th edition) National Health Commission of the People’s Republic of China. https://www.chinalawtranslate.com/en/coronavirus-treatment-plan-7/. Published 2020. Accessed April 6, 2020.Google Scholar
National Center for Medical Quality Control of Kidney Diseases: Expert advice in hemodialysis room (center) to prevent and control the outbreak of novel coronavirus pneumonia. http://www.cnrds.net/Static/OfficialDocumentDown.html.Google Scholar
Expert team of Chinese Medical Association Nephrology Branch. Recommendations for prevention and control of novel coronavirus infection in blood purification center (room) from the Chinese Medical Association Nephrology Branch (Trial Version 1). Chin J Nephrol 36:8284.Google Scholar
State Council of People’s Republic of China. Regulations on the management of medical waste. http://www.gov.cn/banshi/2005-08/02/content_19238.htm Google Scholar
National Environmental Protection Administration & National Administration of Quality Supervision, Inspection and Quarantine. Standards for the discharge of waters in medical institutions. China Environment Press. 2006;GB18466-2005.Google Scholar
Figure 0

Table 1. High-Risk and Suspicious Patient Identification and Classification Management

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