Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

Abstract

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic.

Methods: We conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the "second wave" and "third wave" in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission.

Results: Half of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff.

Conclusions: This survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

Supplementary information: The online version contains supplementary material available at 10.1186/s41100-021-00350-y.

Keywords: COVID-19; Disinfectants; Hemodialysis; Infection prevention measures; Isolation; Japan; Nosocomial transmission; PPEs; Pandemic; SARS-CoV-2.

Fig. 1

Distribution of the period of shortage of personal protective equipment. The distribution of the period of shortage of six personal infection-protective equipment and disinfectants in dialysis facilities is shown. The black bar indicates shortage for more than a month, the gray bar for less than a month, and the white bar for no shortage

Fig. 2

Distribution of the availability of various isolation measures for suspected/diagnosed COVID-19 cases. The distribution of the feasibility of the four isolation measures in dialysis facilities is shown. The black bars indicate the percentage of facilities in which the measure cannot be implemented

Fig. 3

Number of affected patients/staff members in facilities with nosocomial transmission of COVID-19. The number of infected people in the 79 facilities that responded with the details of the number of infected people is shown separately for the staff (white) and for the patients (black). The horizontal axis shows each facility, with a total of 79 bars