COVID-19 is a disease caused by the novel Coronavirus (SARS CoV-2) and people of all ages can get infected. However, the risk of getting infected is more for the elderly and people with ailments like Asthma, Diabetes, Coronary Heart Diseases, Chronic Obstructive Pulmonary diseases and Kidney disease.
Although the COVID-19 is a new disease, the common symptoms have been classified by the World Health Organization (WHO), however, the list is increasing and is a new subject for research for Public Health, epidemiologist and scientist. As far as data compiled at the global level it, has indicated that almost 5% COVID-19 positive cases develops acute kidney Injury who may need to go for dialysis.
Dialysis for normal and COVID-19 patients
The Chronic Kidney Disease Stage-5 (CKD-5) patients on dialysis [maintenance haemodialysis (MHD) or Continuous Ambulatory Peritoneal Dialysis (CAPD)] are also vulnerable group because of their existing comorbidities, repeated unavoidable exposure to the hospital environment and immunosuppressed state due to CKD-5. These patients are therefore not only more prone to acquire infection but also develop severe complications as compared to the general population. Known CKD patient should adhere to the prescribed schedule and not miss their dialysis sessions to avoid any emergency dialysis. “Skipping dialysis can lead to serious adverse effects and increases the risk of hospitalization.”
Dialysis should be continued in the following type of 3 cases during this pandemic
- Patient who are already on dialysis
- Patient who have fallen to Acute Kidney Injury due to COVID-19 complications
- Critically ill Patients requiring renal replacement therapy
Dialysis Guidelines during COVID-19 pandemic
It’s very clear that the dialysis units and wards of most hospitals would be catering to both COVID-19 and normal patients requiring dialysis. Since dialysis patients are more prone to get infected, it is the utmost responsibility to prevent the spread of infection to non-COVID-19 patients. To Stop this contagious disease, here are the WHO approved protocols –
Prepping up the dialysis unit for COVID-19 Crisis:
- Signage in English as well as regional language saying – “To report to nurse or paramedic if any signs or symptoms of COVID-19”
- Working of the dialysis unit at proper appointments, tracking and scheduling so that social distancing norms are also achieved as well as dialysis unit is also functional to its max
- All dialysis unit personnel should be updated with the warning signs of COVID-19
- Universal infection control practices concerning the current pandemic should be followed
- Seven steps Hand Hygiene protocol with at least 60% alcohol-based sanitizer or soap and water for a minimum of 20 seconds to be followed
- Dialysis paramedic, nurse and other staff should be aware of the usage of PPEs
- Patients with COVID symptoms are to be referred to local health authorities
- Dialysis unit personnel should be quarantined if they attend a COVID-19 positive patient
Protocols for Haemodialysis during COVID-19 crisis
For patients
a. Before arrival to the dialysis unit: All units should instruct their patients to recognize early symptoms of COVID-19 (recent onset fever, sore throat, cough, recent shortness of breath/dyspnoea, without major interdialytic weight gain, rhinorrhoea, myalgia/body ache, fatigue and diarrhoea) and contact the dialysis staff before coming to the dialysis centre. The unit needs to make necessary arrangements for their arrival in the screening area.
b. Screening Area
1. It is recommended that dialysis unit should have a designated screening area, where patients can be screened for COVID-19 before allowing them to enter inside the dialysis area. Where it is not possible, patients may wait away from the dialysis unit until they receive specific instructions from the unit staff
2. The screening area should have adequate space to implement social distancing between patients and accompanying persons while waiting for dialysis. In the screening area, every patient should be asked about:
- Symptoms suspected of COVID-19
- History of contact with a diagnosed case of COVID 19
- History of contact with a person who has had recent travel to a foreign country or from high COVID-19 prevalence area
3. Patients with symptoms of respiratory infection should put on a facemask before entering the screening area and keep it on until they leave the dialysis unit. Dialysis unit staff should make sure an adequate stock of masks is available in the screening area to provide to the patients and accompanying person if necessary
4. There should be a display of adequate IEC material (posters etc. about COVID-19 in the screening area
C. Inside Dialysis Unit
1. Suspected or positive COVID-19 patients should properly wear a disposable three-layer surgical mask throughout the dialysis procedure
2. Patients should wash hands with soap and water as per hand hygiene protocols
3. Patients should follow cough etiquettes, like coughing or sneezing by covering the face or using the tissue paper
4. Patients should throw used tissues in the trash. The unit should ensure the availability of plastic-lined trash cans appropriately labelled for disposing of used tissues. The trash cans should be foot-operated ideally to prevent hand contact with infective material
For Dialysis Staff
During Dialysis
1. It should be ensured that a patient or staff in a unit does not become the source of an outbreak
2. Each dialysis chair/bed should have disposable tissues and waste disposal bins to ensure adherence to hand and respiratory hygiene, and cough etiquette and appropriate alcohol-based hand sanitizer within reach of patients and staff
3. Dialysis personnel, attendants and caregivers should also wear a three-layer surgical facemask while they are inside a dialysis unit
4. Ideally, all patients with suspected or positive COVID-19 be dialyzed in isolation. Ways of Isolation can be
- Separate rooms
- Different shifts
- Segregating Dialysis unit in 3 categories, for COVID-19 positive, for COVID-19 suspect and non-COVID-19 patients, if possible at a different level in the hospital
- If the different level is not possible, then different rows with separations can be used
5. Staff caring for suspected or proved cases should not look after other patients during the same shift
6. Dialysis staff should use of proper PPEs for proven or strongly suspected patients of COVID-19. Isolation gowns should be worn over
7. Separating equipment’s like stethoscopes, thermometers, Oxygen saturation probes and blood pressure cuffs between patients with appropriate cleaning and disinfection should be done in between shifts
8. Stethoscope diaphragms and tubing should be cleaned with an alcohol-based disinfectant including hand rubs in between patients
9. Personal Protection and Hygiene, Self- assessment and mindfulness for any early signs and symptoms. If any of the symptoms appear, then one must inform and undergo quarantine for 14 days
Interviewing a Dialysis Technician about tackling the workload during this Pandemic crisis, from a renowned Dialysis Unit in Mumbai, he quoted, “Safety Precautions are Must! As a dialysis technician, we are taking all the steps stated by the World Health Organisation & NKF. Patients are asked to follow all the precautions in Hospital as well as at their home. Till now we are providing good dialysis treatment with all the preventive measures and will also tackle further if the situations are getting worse.” It is necessary to provide emergency care for COVID-19 and non-COVID-19 patients, and staffs who work in such facilities so that they keep the dialysis unit safe and functional.
