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Infection Control Practices in In-Center Hemodialysis Units During Wave 1 of the COVID-19 Pandemic in Ontario,
Angie Yeung1, Anas Aziz1, Leena Taji1
1Ontario Renal Network, Ontario Health, Toronto, Canada.
Insights
Ontario hemodialysis units rapidly implemented infection control measures like screening and masking to protect patients undergoing frequent treatments during the COVID-19 pandemic. This proactive response likely minimized outbreaks in these vulnerable units.
Area of Science:
- Infectious Diseases
- Nephrology
- Public Health
Background:
- Patients on maintenance hemodialysis require frequent treatments, limiting their ability to isolate during the COVID-19 pandemic.
- In-center hemodialysis units in Ontario serve approximately 9000 patients across 100 facilities.
- Robust infection control was critical to prevent SARS-CoV-2 transmission among hemodialysis patients and staff.
Purpose of the Study:
- To track infection control practices implemented by in-center hemodialysis units in Ontario.
- To provide a descriptive narrative of the COVID-19 pandemic response in these units from March to September 2020.
Main Methods:
- Data collected from 27 Ontario renal programs between May and September 2020.
- Focused on key infection control practices: screening, PPE, testing, congregate living protocols, and outbreak management.
- Four data collection cycles, approximately monthly, with results shared provincially.
Main Results:
- By March 2020, most units had symptom screening, physical distancing, and visitor restrictions; 74% implemented universal masking for staff.
- By April 2020, 89% had universal patient masking, 52% enhanced precautions for COVID-19 cases, and 59% regularly tested patients from congregate settings.
- Infection control practices became more standardized across programs over time.
Conclusions:
- Ontario's renal system responded swiftly to mitigate COVID-19 spread in hemodialysis units.
- Provincial teleconferences facilitated sharing of best practices and encouraged local advocacy.
- While direct correlation is unproven, the proactive approach likely contributed to limited outbreaks, offering insights for future infectious disease responses.
Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that caused coronavirus disease 2019 (COVID-19), the multisystem disease central to the COVID-19 pandemic. As patients receiving in-center maintenance hemodialysis require treatment 3 times weekly, they were unable to fully isolate. It was important for in-center hemodialysis units to implement robust infection control practices to ensure patient safety and minimize risk of transmitting SARS-CoV-2 among patients and staff. There are 27 renal programs within Ontario, Canada, providing care for about 9000 people across about 100 in-center hemodialysis units. These units are funded by the Ontario Renal Network (ORN), which is part of the provincial agency Ontario Health.
Objective:
The objective was to track infection control practices that were implemented by in-center hemodialysis units and be able to provide a descriptive narrative of the COVID-19 pandemic response of Ontario's hemodialysis units between March and September 2020.
Methods:
Between May and September 2020, data were collected from Ontario's 27 renal programs on the implementation of key infection control practices, including symptom screening, use of personal protective equipment, testing, practices specifically related to patients from congregate living settings, other prevention practices, and outbreak management. There were 4 data collection cycles, each approximately 1 month apart. The results were compiled and shared across the province, and infection control practices were also discussed at provincial COVID-19 teleconferences hosted by the ORN.
Results:
By March 2020, all but one renal program had implemented one or more forms of symptom screening, all renal programs had implemented physical distancing in waiting rooms and restricted visitors, and 74% of renal programs had implemented universal masking for all staff. By April 2020, 89% of renal programs had implemented universal masking for all patients, 52% had implemented enhanced contact and droplet precautions for suspected or positive cases, and 59% of renal programs tested all patients from congregate living settings regularly (with a low symptom threshold for testing). Infection control practices became more homogeneous across renal programs over time, and most practices were in place as of the last data collection.
Conclusions:
The renal system in Ontario was able to respond quickly within the first 2 months of the pandemic to minimize the spread of COVID-19 within in-center hemodialysis units. Through provincial teleconferences, infection control practices were shared across the province as the pandemic and hemodialysis unit responses evolved. This supported renal programs to advocate locally if their hospital was lagging in practices felt to be of value in other hemodialysis units. Although no direct correlation can be made regarding the implementation of infection control practices within in-center hemodialysis units and the number of COVID-19 cases in this population, the limited number of outbreaks in hemodialysis units may have been influenced by the proactive response of renal programs. Practices described in this article may support management and response to subsequent waves of COVID-19 or future similar infectious diseases.
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