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_ DB - PRIME DP - Unbound Medicine ER -