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A Quality Improvement Project to Minimize COVID-19 Infections in Patients Receiving Haemodialysis and the Role of Routine Surveillance Using Nose and Throat Swabs for SARS-CoV-2 rRT-PCR and Serum Antibody Testing.
Poulikakos, Dimitrios; Chinnadurai, Rajkumar; Mcgee, Yvonne; Gray, Simon; Clough, Toni; Clarke, Nicola; Murphy, Tracey; Wickens, Olivia; Mitchell, Carol; Darby, Denise; Paul, Joel; Chadwick, Paul; Sethi, Su; Sinha, Smeeta; Kalra, Philip A; Donne, Rosie.
  • Poulikakos D; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Chinnadurai R; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
  • Mcgee Y; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Gray S; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
  • Clough T; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Clarke N; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Murphy T; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Wickens O; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Mitchell C; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Darby D; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Paul J; Infection Control Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Chadwick P; Chemical Pathology Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Sethi S; Virology Department, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Sinha S; Microbiology Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
  • Kalra PA; Public Health England, North West Region Specialised Commissioning Team, NHS, London, United Kingdom.
  • Donne R; Renal Department, Salford Royal NHS Foundation Trust, The Northern Care Alliance NHS Group, Manchester, United Kingdom.
Nephron ; 146(4): 335-342, 2022.
Article in English | MEDLINE | ID: covidwho-1582859
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Qualitative research / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Nephron Year: 2022 Document Type: Article Affiliation country: 000520654

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Qualitative research / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Nephron Year: 2022 Document Type: Article Affiliation country: 000520654