RESUMEN
BACKGROUND: Patients receiving in-centre haemodialysis (ICHD) are highly vulnerable to COVID-19. OBJECTIVE: We created a quality improvement (QI) project aimed to eliminate outbreaks of COVID-19 in haemodialysis units and evaluated the utility of surveillance rRT-PCR test and SARS-CoV-2 serum antibodies for prompt identification of patients infected with COVID-19. METHODS: A multifaceted QI programme including a bundle of infection prevention control (IPC) measures was implemented across 5 ICHD units following the first wave of the pandemic in June 2020. Primary outcomes evaluated before and after QI implementation were incidence of outbreaks and severe COVID-19 illness defined as COVID-19-related death or hospitalization. Secondary outcomes included the proportion of patients identified in the pre-symptomatic/asymptomatic phase on surveillance rRT-PCR screening and the incidence and longevity of SARS-CoV-2 antibody response. RESULTS: Following the implementation of the QI project, there were no further outbreaks. Pre- and post-implementation comparison showed a significant reduction in COVID-19-related mortality and hospitalization (26 vs. 13 events, respectively, p < 0.001). Surveillance rRT-PCR screening identified 39 asymptomatic or pre-symptomatic cases out of a total of 59 rRT-PCR-positive patients (39/59, 66%). SARS-CoV-2 antibody levels were detected in 72/74 (97%) rRT-PCR-positive patients. Amongst rRT-PCR-positive patients diagnosed before August 2020, 96% had detectable antibodies until January 2021 (days from the rRT-PCR test to last antibody testing, 245-280). CONCLUSIONS: Systematic implementation of a bundle of IPC measures using QI methodology and surveillance rRT-PCR eliminated outbreaks in HD facilities. Most HD patients mount and sustain antibody response to COVID-19 for over 8 months.
Asunto(s)
COVID-19 , SARS-CoV-2 , Anticuerpos Antivirales/análisis , COVID-19/diagnóstico , Humanos , Faringe/química , Mejoramiento de la Calidad , Diálisis Renal , Reacción en Cadena de la Polimerasa de Transcriptasa InversaAsunto(s)
Infecciones por Coronavirus/epidemiología , Ecocardiografía/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , COVID-19 , Técnicas de Imagen Cardíaca/métodos , Técnicas de Imagen Cardíaca/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Atención a la Salud/métodos , Ecocardiografía/métodos , Femenino , Humanos , Control de Infecciones/métodos , Masculino , Salud Laboral , Pandemias/prevención & control , Seguridad del Paciente , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Síndrome Respiratorio Agudo Grave/diagnóstico , Sociedades Médicas , Estados UnidosAsunto(s)
Enfermedades Cardiovasculares/diagnóstico , Infecciones por Coronavirus , Servicios de Diagnóstico , Ecocardiografía/métodos , Control de Infecciones , Pandemias , Neumonía Viral , Betacoronavirus/aislamiento & purificación , COVID-19 , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Servicios de Diagnóstico/organización & administración , Servicios de Diagnóstico/tendencias , Ecocardiografía/normas , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Ajuste de Riesgo/métodos , Ajuste de Riesgo/organización & administración , SARS-CoV-2 , Estados UnidosAsunto(s)
Betacoronavirus , Cardiología , Enfermedades Cardiovasculares/diagnóstico , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Neumonía Viral/epidemiología , Sociedades Médicas , COVID-19 , Enfermedades Cardiovasculares/complicaciones , Infecciones por Coronavirus/complicaciones , Ecocardiografía , Humanos , Pandemias , Neumonía Viral/complicaciones , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
Sonographers need to be familiar with and prepared to implement strategies for reducing the risk of exposure to and transmission of the COVID-19 virus. Strategies to employ can be grouped into three broad categories: (1) whom to scan, (2) where to scan, and (3) how to scan. Whom to scan addresses sonographer strategies for determining essential and emergent scan status. Where to scan addresses sonographer practice strategies for selecting equipment, use of rooms, portable examinations, and training personnel. How to scan addresses the topics of scanning techniques (tailored protocols, right-handed scanning, use of barrier devices) and equipment cleaning and disinfecting.