Assuntos
Gestão de Mudança , Infecções por Coronavirus , Procedimentos Clínicos , Unidades Hospitalares de Hemodiálise , Controle de Infecções , Falência Renal Crônica , Pandemias , Pneumonia Viral , Diálise Renal , Betacoronavirus/isolamento & purificação , COVID-19 , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/tendências , Reestruturação Hospitalar/métodos , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Diálise Renal/tendências , SARS-CoV-2 , Recursos Humanos/organização & administraçãoRESUMO
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control. MATERIAL AND METHODS: Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability. RESULTS: On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 - 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 - 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine. CONCLUSION: Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe.
Assuntos
Injúria Renal Aguda/terapia , COVID-19/complicações , Terapia de Substituição Renal Contínua/instrumentação , Unidades Hospitalares de Hemodiálise/organização & administração , Terapia de Substituição Renal Intermitente/instrumentação , Pandemias , SARS-CoV-2 , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Anticoagulantes/administração & dosagem , Atitude do Pessoal de Saúde , Terapia de Substituição Renal Contínua/métodos , Terapia de Substituição Renal Contínua/enfermagem , Coleta de Dados , Soluções para Diálise/administração & dosagem , Equipamentos Descartáveis , Educação Continuada em Enfermagem , Desenho de Equipamento , Falha de Equipamento , Heparina/administração & dosagem , Humanos , Terapia de Substituição Renal Intermitente/métodos , Terapia de Substituição Renal Intermitente/enfermagem , Serviço Hospitalar de Engenharia e Manutenção/organização & administração , Eliminação de Resíduos de Serviços de Saúde , Prescrições , Robótica , Inquéritos e Questionários , Realidade VirtualRESUMO
Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.
Assuntos
Infecções Assintomáticas/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Protocolos Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Feminino , Pessoal de Saúde/organização & administração , Unidades Hospitalares de Hemodiálise/organização & administração , Humanos , Incidência , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Prevalência , SARS-CoV-2 , Espanha/epidemiologia , Avaliação de Sintomas , Fatores de Tempo , Triagem/métodos , Adulto JovemRESUMO
In 2020, the COVID-19 pandemic has ravaged the world. Individuals with end-stage kidney disease (ESKD) are at higher risk due to impaired immunity, comorbid conditions, and dependence on travel to medical care settings. We review the salient features of COVID-19 in this population, including the risk of infection, disease course, changes in dialysis unit management, use of investigatory medications, access considerations, home dialysis, and capacity planning.
Assuntos
Infecções por Coronavirus , Unidades Hospitalares de Hemodiálise/organização & administração , Hemodiálise no Domicílio/métodos , Falência Renal Crônica , Pandemias , Pneumonia Viral , Diálise Renal/métodos , Risco Ajustado/métodos , Betacoronavirus , COVID-19 , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Controle de Infecções/métodos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , SARS-CoV-2RESUMO
not available.
Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Unidades Hospitalares de Hemodiálise/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Viremia/diagnóstico , COVID-19 , Teste para COVID-19 , Cuidadores , China , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Desinfecção , Contaminação de Equipamentos/prevenção & controle , Equipamentos e Provisões Hospitalares , Febre/diagnóstico , Humanos , Pacientes , Quartos de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Diálise Renal/instrumentação , Termometria , Viremia/prevenção & controle , Viremia/transmissãoAssuntos
Injúria Renal Aguda/terapia , Infecções por Coronavirus , Serviços Médicos de Emergência/métodos , Unidades Hospitalares de Hemodiálise/organização & administração , Controle de Infecções , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Diálise Renal/métodos , Betacoronavirus , COVID-19 , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Risco Ajustado , SARS-CoV-2RESUMO
The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 (COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5-6% of them may need more aggressive therapies in intensive care. Most governments have recommended social separation and severe measures of prevention of further spreading of the epidemic. Because hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this category of patients requires special attention. In this editorial, we tried to summarize the experience of our centers that hopefully may contribute to help other centers and colleagues that are facing the coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, recommendations for isolation and preventive measures in positive HD patients, and finally directions to manage logistics and personnel are reported. These recommendations should be considered neither universal nor absolute. Instead, they require local adjustments based on geographic location, cultural and social environments, and level of available resources.