There are approximately 700,000 hemodialysis (HD)-dependent ESRD patients in mainland China.During the epidemic of novel coronavirus pneumonia, patients on HD are at high risk of infection. These patients have to go to the facilities for treatments 2 to 3 times a week with each treatment period 4 to 5 hours. Most patients need to take public transportation, which makes them a special “mobile population” in the city. More importantly, these patients are a vulnerable population with low immune function, diabetes, hypertension or other complications. Therefore, it is necessary to strengthen the prevention and management in order to protect HD patients from novel coronavirus infection.
Suggested preventive strategies are as follows:
1. Strengthen disinfection of dialysis facilities and protection of medical staff
a. Perform environmental disinfection after each shift of dialysis, including window ventilation for 30 minutes; air disinfection with hydrogen peroxide spraying; wiping the floor and surface of dialysis machine with 1000-2000 mg/L chlorinated disinfectant; and replacing bedding.
b. Surfaces and supplies contaminated with patients’ excreta, secretions, or blood should be soaked with 2000mg / L chlorinated disinfectant and cleaned separately.
c. Medical staff need to measure and record their body temperature when entering or leaving the dialysis facility. Those with a temperature above 37.3 ℃ are not allowed to enter the facility and must receive relative management. Staff and their family members who have fever, cough, or flulike symptoms, should be isolated and receive medical management.
d. During routine HD procedure, the medical staff should be protected according to level-1 protective strategies (disposable work caps, disposable surgical masks, disposable latex gloves, disposable shoe covers), and all protective supplies need to be replaced in each case. For deep venous catheterization, disposable surgical gowns and goggles are required.
2. Strengthen the protection for patients on maintenance HD and their family members
a. Register the residential address of patients and their family members, and confirm whether there is epidemic at the location and whether they have contacted with diagnosed patients or suspected cases. The medical staff review these information and repeat the register every two weeks.
b. Monitor the body temperature of dialysis patients and caretakers before they enter the facility. Caretakers are not allowed to enter the dialysis treatment area.
c. Ask dialysis patients to wear masks during dialysis treatment.
d. The facility sets up a call on duty and requires patients to report symptoms such as cough, fatigue, and fever during dialysis intervals to the medical staff on duty, and follow their instructions.
e. Provide preventive education for patients on HD. Let patients understand the importance of prevention and isolation, and know the correct protective strategies. Help patients to overcome their fear of the epidemic.
f. Use APP for medical consultation, follow-up, and regular drug prescription to reduce the requirement of clinic visit.
We are confident that, through the joint effort of medical staff and patients, we will win the fight against the novel coronavirus!