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COVID-19 Outbreak in an Urban Hemodialysis Unit.
Am J Kidney Dis. 2020 11; 76(5):690-695.e1.AJ

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.

STUDY DESIGN

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).

ANALYTICAL APPROACH

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.

Authors+Show Affiliations

St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.Centre Hospitalier de l'Université de Montréal, Montréal, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada.St. Michael's Hospital, Toronto, Canada. Electronic address: ron.wald@unityhealth.to.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32681983

Citation

Yau, Kevin, et al. "COVID-19 Outbreak in an Urban Hemodialysis Unit." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 76, no. 5, 2020, pp. 690-695.e1.
Yau K, Muller MP, Lin M, et al. COVID-19 Outbreak in an Urban Hemodialysis Unit. Am J Kidney Dis. 2020;76(5):690-695.e1.
Yau, K., Muller, M. P., Lin, M., Siddiqui, N., Neskovic, S., Shokar, G., Fattouh, R., Matukas, L. M., Beaubien-Souligny, W., Thomas, A., Weinstein, J. J., Zaltzman, J., & Wald, R. (2020). COVID-19 Outbreak in an Urban Hemodialysis Unit. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 76(5), 690-e1. https://doi.org/10.1053/j.ajkd.2020.07.001
Yau K, et al. COVID-19 Outbreak in an Urban Hemodialysis Unit. Am J Kidney Dis. 2020;76(5):690-695.e1. PubMed PMID: 32681983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 Outbreak in an Urban Hemodialysis Unit. AU - Yau,Kevin, AU - Muller,Matthew P, AU - Lin,Molly, AU - Siddiqui,Naureen, AU - Neskovic,Sanja, AU - Shokar,Gagan, AU - Fattouh,Ramzi, AU - Matukas,Larissa M, AU - Beaubien-Souligny,William, AU - Thomas,Alison, AU - Weinstein,Jordan J, AU - Zaltzman,Jeffrey, AU - Wald,Ron, Y1 - 2020/07/15/ PY - 2020/05/25/received PY - 2020/07/02/accepted PY - 2020/7/19/pubmed PY - 2020/11/3/medline PY - 2020/7/19/entrez KW - Coronavirus 2019 (COVID-19) KW - asymptomatic infection KW - dialysis clinic KW - end-stage kidney disease (ESKD) KW - hemodialysis KW - infection prevention KW - kidney failure KW - nasopharyngeal swabs KW - nosocomial transmission KW - outbreak KW - screening KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) SP - 690 EP - 695.e1 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 76 IS - 5 N2 - 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. STUDY DESIGN: 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). ANALYTICAL APPROACH: 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/32681983/COVID_19_Outbreak_in_an_Urban_Hemodialysis_Unit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(20)30811-8 DB - PRIME DP - Unbound Medicine ER -