Guidelines for Dialysis with reference to COVID-19 Infection

Dialysis-COVID-19-Infection

General Guidance for Dialysis Unit

  1. A sign board to report any fever, coughing or breathing problem in dialysis unit and waiting area.
  2. All staff should strictly follow hand hygiene. Avoid touching your eyes, nose, and mouth with unwashed hands
  3. Protocol to be made and inform to concerned authorities if our old patient comes covid 19 positive.
  4. The dialysis unit staff should be trained for donning and doffing of Personal Protective Equipment (PPE) to be used for dialysis of COVID-19 positive patients.
  5. All patients on dialysis, suspected of COVID – 19 should be tested with RT – PCR test as per Government of India protocol.
  6. Protocol to be made and inform to concerned authorities if our old patient is suspected for covid 19.
  7. Educate nephrologists, nurses, technicians, other staff and all patients undergoing MHD along with their care givers about COVID 19

I. For Patients 

A. Before Arrival to Dialysis Unit
  1. All units should instruct their patients to recognize early symptoms of COVID-19 (recent onset fever, Sore throat, Cough, recent Shortness of breath/dyspnea, without major interdialytic weight gain, rhinorrhea, myalgia/bodyache, fatigue and Diarrhea)and contact dialysis staff before coming to dialysis center. The unit needs to make necessary arrangement for their arrival in the screening area. 2. Patients, who are stable on MHD may be encouraged to come to the unit alone without any attendant
B. Screening Area
  1. Should have a designated screening area, where patients can be screened for COVID-19 before allowing them to enter inside dialysis area. Where this is not possible, patients may wait away from the dialysis unit until they receive specific instructions from the unit staff.
  2. The screening area should have adequate space.
    In screening area, every patient should be asked about:
  • Symptoms suspected of COVID-19 as above.
  • History of contact with a diagnosed case of COVID 19
  • History of contact with person who has had recent travel to foreign country or from high COVID-19 prevalence area
  1. Every patient and accompanying person should put on a facemask and to make their wash hands with soap and water before entering to hospital.
C. Inside Dialysis Unit
  1. Suspected or positive COVID-19 patients should properly wear disposable three-layer surgical mask throughout dialysis duration.
  2. To use hand sanitizer before entering to dialysis unit.

II. For Dialysis Staff 

To make list of all patients with addresses and correlate with hot spots areas for covid 19 infection During Dialysis

  1. All staff to wear a three-layer surgical facemask while they are inside dialysis unit.
  2. Suspected or positive COVID-19 be dialyzed in isolation. If not be possible use of a separate shift, preferably the last of the day for dialyzing all such patients or to physically separate areas for proven positive and suspected cases.
  3. Dialysis staff should use of all personal protective equipment (PPE) for proven or strongly suspected patients of COVID-19.
  4. Separating equipments like stethoscopes, thermometers, Oxygen saturation probes and blood pressure cuffs between patients with appropriate cleaning and disinfection should be done in between shifts.
  5. Stethoscope diaphragms and tubing should be cleaned with an alcohol-based disinfectant including hand rubs in between patients. As most NIBP sphygmomanometer cuffs are now made of rexine they should also be cleaned by alcohol or preferably hypochloritebased (1% Sodium Hypochlorite) solutions
  6. Staff using PPE should be careful of the following issues:

While using PPE, they will not be able to use wash room so prepare accordingly

If dialysis is to be done bed-side in the hospital, portable RO should be properly disinfected with hypochlorite (1% Sodium Hypochlorite) solution between use of two patients

DISINFECTION AND DISPOSAL PRACTICES IN DIALYSIS UNIT 

Cloth gowns should be soaked in a 1% hypochlorite solution for 20 minutes before sluicing and then be transported for laundering after each use.

Inside dialysis unit, clean and disinfect frequently touched surfaces at least thrice daily and after every shift.

PERSONAL PROTECTIVE EQUIPMENTS (PPE) Personal protective equipment must be used while dialyzing COVID-19 positive patients. These include:

Shoe covers

Gown

Surgical cap or hood

Goggles or eye shields

Mask: Ideally all masks should be N95 respirators with filters.

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