Mitigating Risk of COVID-19 in Dialysis Facilities
Alan S. Kliger, Jeffrey Silberzweig. Mitigating Risk of COVID-19 in Dialysis Facilities. CJASN May 2020, 15 (5) 707-709; DOI: 10.2215/CJN.03340320
Review written by:
Tara Lucian, edited by Elizabeth Harty
Yellow - This paper was published in a reputable journal based on joint advice from the CDC and the ASN.
Before appointment: Patients who exhibit symptoms of COVID-19 (fever, new cough, or dyspnea), have traveled to an area with community spread, or have had contact with a confirmed COVID-19 case should call the dialysis center ahead of their arrival. All patients should be screened for this information upon arrival
During appointment: Suspected and confirmed cases should be treated in a separate room with a closed door. If that is not possible, then appointments should be organized such that suspected or confirmed cases are treated during dedicated isolation shifts or in designated COVID-19 facilities. If asymptomatic and symptomatic individuals must be treated at the same time, symptomatic individuals should be treated in corner or end-of-row stations, at least 6 feet apart. All patients should be provided tissues to cover their nose and mouth when coughing or sneezing. Dialysis staff should employ standard contact and droplet precautions, including isolation gowns, gloves, masks, and eye protection during appointments, prioritizing gowns for initiating and terminating dialysis, manipulating access needles and catheters, assisting patients to and from the dialysis station, and disinfecting if supplies are low. If N95 masks are not available, standard surgical face masks are recommended.
After appointment: Reusable eye shields should be cleaned and disinfected according to manufacturer instructions. Staff should clean the dialysis machine, all parts of the dialysis chair, all station surfaces, and other equipment (BP cuffs and stethoscopes) with disinfectant wipes and allow them to air dry. Disinfection personnel should use the same PPE as caregivers treating confirmed COVID-19 cases. Dialysis facilities that encounter possible cases should communicate with local health authorities.
It is anticipated that guidance will be modified as data emerges in this dynamic public health event. Monitor CDC updates here:
Interim Additional Guidance for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities
Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings