COVID-19 Outbreak in an Urban Hemodialysis Unit.
Am J Kidney Dis
; 76(5): 690-695.e1, 2020 11.
Article
in English
| MEDLINE | ID: covidwho-644927
ABSTRACT
RATIONALE & OBJECTIVE:
Hemodialysis patients are at increased risk for coronavirus disease 2019 (COVID-19) transmission due in part to difficulty maintaining physical distancing. Our hemodialysis unit experienced a COVID-19 outbreak despite following symptom-based screening guidelines. We describe the course of the COVID-19 outbreak and the infection control measures taken for mitigation. STUDYDESIGN:
Retrospective cohort study. SETTING &PARTICIPANTS:
237 maintenance hemodialysis patients and 93 hemodialysis staff at a single hemodialysis center in Toronto, Canada. EXPOSURE Universal screening of patients and staff for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OUTCOMES:
The primary outcome was detection of SARS-CoV-2 in nasopharyngeal samples from patients and staff using reverse transcriptase-polymerase chain reaction (RT-PCR). ANALYTICALAPPROACH:
Descriptive statistics were used for clinical characteristics and the primary outcome.RESULTS:
11 of 237 (4.6%) hemodialysis patients and 11 of 93 (12%) staff members had a positive RT-PCR test result for SARS-CoV-2. Among individuals testing positive, 12 of 22 (55%) were asymptomatic at time of testing and 7 of 22 (32%) were asymptomatic for the duration of follow-up. One patient was hospitalized at the time of SARS-CoV-2 infection and 4 additional patients with positive test results were subsequently hospitalized. 2 (18%) patients required admission to the intensive care unit. After 30 days' follow-up, no patients had died or required mechanical ventilation. No hemodialysis staff required hospitalization. Universal droplet and contact precautions were implemented during the outbreak. Hemodialysis staff with SARS-CoV-2 infection were placed on home quarantine regardless of symptom status. Patients with SARS-CoV-2 infection, including asymptomatic individuals, were treated with droplet and contact precautions until confirmation of negative SARS-CoV-2 RT-PCR test results. Analysis of the outbreak identified 2 index cases with subsequent nosocomial transmission within the dialysis unit and in shared shuttle buses to the hemodialysis unit.LIMITATIONS:
Single-center study.CONCLUSIONS:
Universal SARS-CoV-2 testing and universal droplet and contact precautions in the setting of an outbreak appeared to be effective in preventing further transmission.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Renal Dialysis
/
Infection Control
/
Coronavirus Infections
/
Disease Transmission, Infectious
/
Pandemics
/
Betacoronavirus
/
Hemodialysis Units, Hospital
/
Kidney Failure, Chronic
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
Limits:
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Am J Kidney Dis
Year:
2020
Document Type:
Article
Affiliation country:
J.ajkd.2020.07.001
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