COVID-19 infection control measures and outcomes in urban dialysis centers in predominantly African American communities

Abstract

Background Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. Methods Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1–May 31, 2020 were included; with a follow-up period spanning March–June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. Results Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%) were female. Eleven patients (47.8%) were residents of nursing homes. Nineteen patients (82.6%) required hospitalization and 6 patients (26.1%) died; the average number of days from a positive SARS-CoV-2 (COVID) test to death was 16.8 days (range 1–34). Two patients dialyzing at adjacent dialysis stations and a dialysis staff who cared for them, were diagnosed with COVID-19 in a time frame that may suggest transmission in the dialysis facility. In response, universal masking in the facility was implemented (prior to national guidelines recommending universal masking), infection control audits and re-trainings of PPE were also done to bolster infection control practices. Conclusion We successfully implemented recommended COVID-19 infection control measures aimed at mitigating the spread of SARS-CoV-2. Most of the patients with COVID-19 required hospitalizations. Dialysis facilities should remain vigilant and monitor for possible transmission of COVID-19 in the facility.

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“…This theme addressed eight studies that focused on protecting vulnerable residents during the epidemic ( 43 , 46 , 52 , 57 – 59 , 61 , 64 ). Two subthemes underpinned this theme: physical health service for physically disadvantaged residents and mental health service for spiritually vulnerable residents.…”

Enhanced Sentinel Surveillance System for COVID-19 Outbreak Prediction in a Large European Dialysis Clinics Network

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“…Social distancing, preventive quarantine, and the isolation of infected subjects still represents the most effective means to reduce the risk of SARS-CoV-2 human-to-human transmission [ 8 , 9 ]. However, patients with end-stage kidney disease (ESKD) need to undergo in-center dialysis three times per week for 4 h per session, which makes physical distancing more difficult to achieve due to repeated, prolonged interactions with other patients and healthcare staff [ 10 , 11 , 12 , 13 ]. Unfortunately, ESKD individuals also show a higher risk of complications following SARS-CoV-2 infection due to weakened immune response [ 14 , 15 , 16 , 17 ] and to the occurrence of many of the risk factors commonly associated with development of severe COVID-19 [ 18 , 19 ], including older age and comorbidities [ 20 , 21 ].…”

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