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Core principles for infection prevention in hemodialysis centers during the COVID-19 pandemic

Year: 2020

Type: article

Abstract: To the Editor-The COVID-19 outbreak began at the end of December 2019, and >600,000 confirmed cases had been reported worldwide by the end of March 2020.The World Health Organization declared a global pandemic. 1Nosocomial transmission was severe in some locations, and the burden to the health system was extreme. 2 Hemodialysis centers, which generally serve high volumes of highly mobile dialysis patients, have an exceptionally high risk of exposure during this outbreak period.In a general tertiary-care hospital, dialysis centers routinely accept patients from outpatient clinics and emergency rooms, further adding to the difficulty of preventing nosocomial infection. 3Dialysis patients, commonly regarded as immune compromised, are likely to develop severe illness as a result of close contact in a medical unit.Droplet spread and close contact are the main routes of COVID-19 transmission. 4Thus, the hemodialysis center in our hospital implemented multiple strategies for infection prevention, including area management and integrated symptom monitoring, in the context of this pandemic.Based on various levels of exposure to the mobile population, our hospital environments were classified as low-risk, mediumrisk, high-risk, and extremely high-risk, and the dialysis center belongs to the high-risk category.We avoid moving across the area by designing a specific walking route for our patients entering the hemodialysis center.Medical staff wears personal protective equipment (PPE) when inter-area contact is inevitable.For example, N95 masks and protective glasses are required when entering the fever clinic.We advise the use of hand sanitizer whenever staff return to the hemodialysis center.In the dialysis center, a 1-way route is followed by our patients, and mask-wearing and hand sanitizing by the patients are ensured.During the dialysis session, we provide necessary education on maintaining social distancing and self-protection.Between the 2 dialysis shifts, we strictly leave at least 30 minutes for environmental and air disinfection, and we utilize a chlorine-containing disinfectant to clean our dialysis facilities. [6][7]][8] We monitor and respond to our regular patients' symptoms in an integrated way.Between the dialysis sessions, we strictly record the body temperatures and any suspicious respiratory symptoms of our patients.For patients referred from other departments in the hospital, we collect records of their contact history, temperature, and potential warning symptoms before admission.Based on this information, all of our patients are classified into 3 categories (Table 1).A negative SARS-CoV-2 swab test is needed for patients

Source: Infection Control and Hospital Epidemiology

DOI: 10.1017/ice.2020.109