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COVID-19 Outbreak in an Urban Hemodialysis Unit.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2020 Nov; Vol. 76 (5), pp. 690-695.e1. Date of Electronic Publication: 2020 Jul 15. - Publication Year :
- 2020
-
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.<br />Study Design: Retrospective cohort study.<br />Setting & Participants: 237 maintenance hemodialysis patients and 93 hemodialysis staff at a single hemodialysis center in Toronto, Canada.<br />Exposure: Universal screening of patients and staff for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).<br />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).<br />Analytical Approach: Descriptive statistics were used for clinical characteristics and the primary outcome.<br />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.<br />Limitations: Single-center study.<br />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.<br /> (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- COVID-19
Canada
Female
Health Personnel statistics & numerical data
Humans
Male
Middle Aged
Occupational Exposure prevention & control
Retrospective Studies
Risk Factors
SARS-CoV-2
Betacoronavirus isolation & purification
Coronavirus Infections epidemiology
Coronavirus Infections prevention & control
Coronavirus Infections transmission
Disease Transmission, Infectious prevention & control
Disease Transmission, Infectious statistics & numerical data
Hemodialysis Units, Hospital statistics & numerical data
Infection Control methods
Infection Control organization & administration
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic therapy
Pandemics prevention & control
Pneumonia, Viral epidemiology
Pneumonia, Viral prevention & control
Pneumonia, Viral transmission
Renal Dialysis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 76
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 32681983
- Full Text :
- https://doi.org/10.1053/j.ajkd.2020.07.001