tetano
Editor, Senior Moderator
Am J Kidney Dis
. 2020 Jul 15;S0272-6386(20)30811-8.
doi: 10.1053/j.ajkd.2020.07.001. Online ahead of print.
COVID-19 Outbreak in an Urban Hemodialysis Unit
Kevin Yau[SUP] 1 [/SUP], Matthew P Muller[SUP] 1 [/SUP], Molly Lin[SUP] 1 [/SUP], Naureen Siddiqui[SUP] 1 [/SUP], Sanja Neskovic[SUP] 1 [/SUP], Gagan Shokar[SUP] 1 [/SUP], Ramzi Fattouh[SUP] 1 [/SUP], Larissa M Matukas[SUP] 1 [/SUP], William Beaubien-Souligny[SUP] 2 [/SUP], Alison Thomas[SUP] 1 [/SUP], Jordan J Weinstein[SUP] 1 [/SUP], Jeffrey Zaltzman[SUP] 1 [/SUP], Ron Wald[SUP] 3 [/SUP]
Affiliations
Abstract
Rationale & objective: Hemodialysis patients are at increased risk for COVID-19 transmission due, in part, to difficulty maintaining physical distancing. Our hemodialysis unit experienced a COVID-19 outbreak despite following symptom-based screening guidelines. We describe the course of the COVID-19 outbreak and the infection control measures taken for mitigation.
Study design: Retrospective cohort study SETTING & PARTICIPANTS: 237 maintenance hemodialysis patients and 93 hemodialysis staff at a single hemodialysis centre in Toronto, Canada.
Exposure: Universal screening of patients and staff with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Outcomes: The primary outcome was detection of SARS-CoV-2 in nasopharyngeal samples from patients and staff using reverse transcriptase-polymerase chain reaction (RT-PCR) .
Analytical approach: Descriptive statistics were used for clinical characteristics and the primary outcome.
Results: Eleven (4.6%) of 237 hemodialysis patients and 11 of 93 (12%) staff members had a positive RT-PCR test for SARS-CoV-2. Among individuals testing positive, 12 of 22 (55%) were asymptomatic at time of testing, and 7 of 22 (32%) were asymptomatic for the duration of follow-up. One patient was hospitalized at the time of SARS-CoV-2 infection and four additional patients with positive tests were subsequently hospitalized. Two patients (18%) required admission to the intensive care unit. After 30 days follow-up no patients had died or required mechanical ventilation. No hemodialysis staff required hospitalization. Universal droplet and contact precautions were implemented during the outbreak. Hemodialysis staff with SARS-CoV-2 infection were placed on home quarantine regardless of symptom status. Patients with SARS-CoV-2 infection including asymptomatic individuals were treated with droplet and contact precautions until confirmation of negative SARS-CoV-2 RT-PCR testing. Analysis of the outbreak identified two index cases with subsequent nosocomial transmission within the dialysis unit and in shared shuttle buses to the hemodialysis unit.
Limitations: Single centre study.
Conclusions: Universal SARS-CoV-2 testing and universal droplet and contact precautions in the setting of an outbreak appeared to be effective in preventing further transmission.
Keywords: Dialysis; End-Stage Kidney Disease (ESKD); Hemodialysis; Infection; Kidney Failure; Nasopharyngeal Swabs; Nosocomial; Outbreak; Screening; coronavirus 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
. 2020 Jul 15;S0272-6386(20)30811-8.
doi: 10.1053/j.ajkd.2020.07.001. Online ahead of print.
COVID-19 Outbreak in an Urban Hemodialysis Unit
Kevin Yau[SUP] 1 [/SUP], Matthew P Muller[SUP] 1 [/SUP], Molly Lin[SUP] 1 [/SUP], Naureen Siddiqui[SUP] 1 [/SUP], Sanja Neskovic[SUP] 1 [/SUP], Gagan Shokar[SUP] 1 [/SUP], Ramzi Fattouh[SUP] 1 [/SUP], Larissa M Matukas[SUP] 1 [/SUP], William Beaubien-Souligny[SUP] 2 [/SUP], Alison Thomas[SUP] 1 [/SUP], Jordan J Weinstein[SUP] 1 [/SUP], Jeffrey Zaltzman[SUP] 1 [/SUP], Ron Wald[SUP] 3 [/SUP]
Affiliations
- PMID: 32681983
- DOI: 10.1053/j.ajkd.2020.07.001
Abstract
Rationale & objective: Hemodialysis patients are at increased risk for COVID-19 transmission due, in part, to difficulty maintaining physical distancing. Our hemodialysis unit experienced a COVID-19 outbreak despite following symptom-based screening guidelines. We describe the course of the COVID-19 outbreak and the infection control measures taken for mitigation.
Study design: Retrospective cohort study SETTING & PARTICIPANTS: 237 maintenance hemodialysis patients and 93 hemodialysis staff at a single hemodialysis centre in Toronto, Canada.
Exposure: Universal screening of patients and staff with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Outcomes: The primary outcome was detection of SARS-CoV-2 in nasopharyngeal samples from patients and staff using reverse transcriptase-polymerase chain reaction (RT-PCR) .
Analytical approach: Descriptive statistics were used for clinical characteristics and the primary outcome.
Results: Eleven (4.6%) of 237 hemodialysis patients and 11 of 93 (12%) staff members had a positive RT-PCR test for SARS-CoV-2. Among individuals testing positive, 12 of 22 (55%) were asymptomatic at time of testing, and 7 of 22 (32%) were asymptomatic for the duration of follow-up. One patient was hospitalized at the time of SARS-CoV-2 infection and four additional patients with positive tests were subsequently hospitalized. Two patients (18%) required admission to the intensive care unit. After 30 days follow-up no patients had died or required mechanical ventilation. No hemodialysis staff required hospitalization. Universal droplet and contact precautions were implemented during the outbreak. Hemodialysis staff with SARS-CoV-2 infection were placed on home quarantine regardless of symptom status. Patients with SARS-CoV-2 infection including asymptomatic individuals were treated with droplet and contact precautions until confirmation of negative SARS-CoV-2 RT-PCR testing. Analysis of the outbreak identified two index cases with subsequent nosocomial transmission within the dialysis unit and in shared shuttle buses to the hemodialysis unit.
Limitations: Single centre study.
Conclusions: Universal SARS-CoV-2 testing and universal droplet and contact precautions in the setting of an outbreak appeared to be effective in preventing further transmission.
Keywords: Dialysis; End-Stage Kidney Disease (ESKD); Hemodialysis; Infection; Kidney Failure; Nasopharyngeal Swabs; Nosocomial; Outbreak; Screening; coronavirus 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).