Outpatient hemodialysis unit preparedness during COVID-19 pandemic in several dialysis units in New York State

ABSTRACT

Background: HD units are clustered close contact environments where prolonged and repeated exposure to blood borne pathogens occurs. Weeks into the CoVID-19 pandemic, wide disparities in rates of death and exposure of staff and patients amongst HD units in the same zip code of an epicenter in New York regions emerged. Methods: Random HD units surveyed as to when and what infection control measures they implemented. Direct input into RedCap and SAS 9.0 analysis of the data conducted. Results: 15 HD units (average census 18-240) responded. Survey compiled exposure rates from 3/1/20 - 4/30/20. The 1st reported case of CoVID-19 by a facility was 3/2/20. Most facilities reported outbreaks (4-30 cases per facility) by 3/21/20. Missed HD sessions due to CoVID varied from 2-100, hospital stays for such patients varied from 2-20 days and death rates from 0-15 per facility. 4 of 15 facilities reported deaths of family members of exposed patients and impediments in logistics of single person transportation forcing carpooling. Home dialysis programs reported minimal deaths and exposures. 20% of facilities had no infection preventionist and 26% no patient educator. Reported waiting area cleaning and hand sanitizer refill rates ranged from 1-5 times per day. 20% of the facilities have < 6 feet distance between patients. Implementation of infection control practices such as wearing of masks by patients varied widely amongst units. Some started March 1st-March 16th, some later due to mixed messages of its importance. Lack of personal protective equipment (PPE)(in 13% of facilities), staff, and housekeeping shortages (6.7-13.3%) compounded the problems. Positive CoVID results had 1-10 staff members infected per facility with sick call rates from 7-30 days, and no staff death. 46% of the HD units don't belong to the CDC coalition. Conclusions: Maintenance of strict hand hygiene, proper air flow, repeated environmental surface cleansing, availability of PPE, and patient and staff education remain the corner stone in preventing infections from spreading. Lack of leadership support and failing to share best practices between dialysis units in the US remains prohibitive but must be encouraged and standardized.