Infection Control Precautions and Care Delivery in Hemodialysis Unit during Coronavirus Disease 2019 Outbreak: A Case Series

Abstract

Background: With an estimated basic reproductive number of 3.77, the Coronavirus Disease 2019 (COVID-19) continues to spread. It is urgent to exert adequate efforts for the management of dialysis patients, caregivers, and healthcare personnel (HCP). This study aimed at reporting practical workflow, identification of high-risk or suspected cases of CO-VID-19, and subsequent response measures.

Methods: At the time of the COVID-19 outbreak, precautions and practice protocols were applied in our dialysis units (DUs). This single-center study retrospectively reviewed all high-risk/suspected cases from January 23, 2020, to February 10, 2020. Epidemiological, clinical feature, and detailed data on all cases were recorded.

Results: Practical workflow for the clinical management of dialysis patients, caregivers, and HCP was initiated. A total of 6 high-risk/suspected cases were identified. Female gender, older age, presence of cardiovascular disease, diabetes, anuresis, immunocompromised status, hypoalbuminemia, and underweight were noticeable features in these cases. Direct evidence of infection or epidemiological risk was detected in five cases. Close monitoring for temperature and oxygen saturation during hemodialysis sessions may be reasonable. No confirmed COVID-19 cases were reported in our DU, but certain cases showed rapid deterioration due to other critically severe condition needing hospitalization. Portable dialysis machines are of great need to ensure dialysis care provision.

Conclusions: Our study described a practical workflow for patient-centered management during COVID-19 outbreak. Potential risk factors and underlying clinical patterns were reported. Further studies regarding the efficacy of infection control precautions and practice protocols tailored for dialysis settings are warranted.

Keywords: Care delivery; Coronavirus disease 2019; Dialysis unit; Hemodialysis; Infection control precautions.

Fig. 1

Workflow for patient-centered management in a dialysis setting during COVID-19 outbreak. *Epidemiological investigation includes travel history, contact history, and other exposure history where the local epidemiological situation was adapted, as described in the WHO interim guidance [8]. **Screening includes clinical assessment, laboratory testing for complete blood count, high-sensitivity C-reactive protein, serum biochemistry, identification of other respiratory pathogens (such as influenza A virus [H1N1, H3N2, H7N9], influenza B virus, respiratory syncytial virus, and adenovirus), and computed tomography of the thorax. HD, hemodialysis; HCP, healthcare personnel; COVID-19, coronavirus disease 2019; CRRT, continuous renal replacement therapy.

Fig. 2

Workflow for the management of non-dialysis-dependent patients who have indications for acute dialysis when COVID-19 is suspected. *Referring to immediate or delayed dialysis [26]; the latter means to start dialysis in response to severe metabolic acidosis, severe hyperkalemia, pulmonary edema, 72 h of oliguria, or a blood urea concentration of >37 mmol/L. RRT, renal replacement therapy; ICU, intensive care unit; COVID-19, coronavirus disease 2019.