Related Experiment Video
Updated: Jul 7, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
An Interprofessional Approach in Caring for a Patient on Maintenance Hemodialysis with COVID-19 in Toronto, Canada:
Elizabeth M Hendren1, Nicola Matthews1, Mathew Oliver1,2
1Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Insights
Implementing rigorous screening protocols and staff education is crucial for preventing COVID-19 outbreaks in hemodialysis units. Early intervention for patients with SARS-CoV-2 symptoms can mitigate severe complications.
Area of Science:
- Infectious Diseases
- Nephrology
- Public Health
Background:
- Hemodialysis patients face elevated COVID-19 risk due to frequent healthcare interactions and comorbidities.
- The study details the clinical course of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre.
- Lessons learned and practice changes implemented to prevent a center-wide outbreak are presented.
Purpose of the Study:
- To document the clinical trajectory of the first COVID-19-positive hemodialysis patient.
- To identify and implement changes in screening practices to prevent COVID-19 outbreaks in a hemodialysis unit.
- To share lessons learned regarding patient and staff safety during the COVID-19 pandemic.
Main Methods:
- A case study approach followed the first COVID-19-positive maintenance hemodialysis patient.
- An interprofessional team utilized rapid Plan-Do-Study-Act quality improvement cycles.
- Screening protocols were enhanced to improve patient and staff safety within the hemodialysis unit.
Main Results:
- The patient developed severe COVID-19 complications including hypoxia and acute respiratory distress syndrome.
- The implemented quality improvement cycles led to revised screening protocols.
- The clinical course of the patient and the impact of interventions were documented.
Conclusions:
- Continuous review of infection screening processes is essential for preventing COVID-19 outbreaks in hemodialysis settings.
- Prompt hospital admission for patients with hemodynamic compromise or hypoxia is recommended.
- Early education and refresher training on personal protective equipment are vital for healthcare worker safety and outbreak prevention.
Rationale:
Hemodialysis patients are at significant risk from COVID-19 due to their frequent interaction with the health care system and medical comorbidities. We followed up the trajectory of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre in Toronto. We present the lessons learned and changes in practices that occurred to prevent an outbreak in our center.
Presenting Concerns Of The Patient:
The patient, a 66-year-old woman on in-center hemodialysis, initially presented with a 2-day history of a productive cough. She subsequently developed a fever, was placed on contact and droplet isolation, and admitted to hospital.
Diagnoses:
On March 13, 2020, the patient tested positive for COVID-19. Within the next 48 hours, she developed hypoxia and acute respiratory distress syndrome as a complication of her illness requiring an extended critical care stay. This extended critical care stay resulted in critical illness-associated secondary sclerosing cholangitis.
Interventions:
An interprofessional team was established, performing rapid Plan-Do-Study-Act quality improvement cycles to improve screening practices and promote the safety of patients and staff in the hemodialysis unit.
Outcomes:
We present here the lessons learned, the changes to our screening protocols, and the clinical course of our first in-center hemodialysis patient with SARS-CoV-2.
Teaching Points:
Regular review of the infection screening processes is paramount in preventing outbreaks of COVID-19, particularly in hemodialysis units. Hospital admission should be arranged if a patient exhibits any clinical signs of hemodynamic compromise or hypoxia. Early education for health care practitioners caring for patients with COVID-19 and refresher information regarding personal protective equipment helped promote the safety of staff and prevent health care-associated outbreaks.
Related Concept Videos
01:25Peritoneal Dialysis III: Nursing Management
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:20Acute Kidney Injury V: Interprofessional Care
01:28Chronic Kidney Disease III: Interprofessional Care