Guidelines for Infection Prevention & Control in Dialysis Services During COVID-19
Special healthcare services like dialysis require specific attention during the COVID-19 pandemic. This overview covers the challenges faced and provides guidelines for staff, patients, and the environment. Topics include general instructions for dialysis unit staff, monitoring of staff, and patient segregation to prevent the spread of infection. Recommendations from the Government of India are highlighted to ensure proper infection prevention and control measures are in place.
- Infection Prevention
- Dialysis Services
- COVID-19 Guidelines
- Healthcare Facilities
- Patient Segregation
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IPC Webinar IPC in Essential Services IPC in Essential Services Dialysis and Labour Room Dialysis and Labour Room Dr Raman Sardana Secretary, Hospital Infection Society India Head, Microbiology and Infection Prevention and Control, Indraprastha Apollo Strengthening Infection Prevention & Control for COVID-19 in Healthcare Facilities focus on Private Sector | 4 May 2020
Overview Overview Special Services have their own challenges and need special focus The staff, equipment, patients and the environment demands are general also and very specific Here we would give an overview of two such services which have a greater potential to be utilized during current circumstances
COVID and IPC in Dialysis Services COVID and IPC in Dialysis Services
General Instructions for Dialysis Unit Staff General Instructions for Dialysis Unit Staff Stable patients, on maintenance haemodialysis (MHD) encourage to come alone without any attendant Patients on MHD should adhere to prescribed schedule not to miss dialysis sessions to avoid emergency dialysis Maintaining supply lines and dialysis unit upkeep Creating patient awareness on reporting symptoms early Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
General Instructions for Dialysis Unit General Instructions for Dialysis Unit Monitoring of staff self and system based for early pickup of infected staff Organise shift duties of healthcare workers Staff awareness, education and relevant training Follow standard precautions before, during and in between patients Follow and maintain hand hygiene and personal hygiene Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
Segregation of patients Segregation of patients Screening area to segregate into NON COVID Suspect COVID Each housed separately Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
Screening of patients and attendants Screening of patients and attendants All patients and attendants before entering the dialysis unit Screening for temperature Declaration form of contact/travel Self-assessment form to recognize early symptoms of COVID-19 recent onset fever, sore throat, cough, recent shortness of breath/dyspnoea, without major interdialytic weight gain, rhinorrhoea, body ache, fatigue and diarrhoea Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
Inside Dialysis Unit Inside Dialysis Unit COVID positive COVID positive Suspected or COVID-19 positive patients to be housed separately Dialysis patients to wear triple layer mask throughout dialysis Standard precautions Hand hygiene soap and water or hand sanitizer Cough etiquette; used tissues to be disposed as per BMW guidelines IEC resources about COVID-19 to be displayed in the dialysis area Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
During dialysis During dialysis Ensure that a patient or staff does not become the source of an outbreak Each dialysis chair/bed shall have disposable tissues and waste disposal bins and hand hygiene resources Dialysis beds/chairs are separated by at least 1 metre distance Dialysis personnel, attendants and caregivers shall wear a three-layer surgical facemask while inside dialysis unit Full PPE to be worn when attending to COVID patients or COVID area or while doing an aerosol generating procedure Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
Testing and Positivity Testing and Positivity All patients on dialysis, suspected of COVID-19 shall be tested with rRT-PCR test as per ICMR/State government protocol Patients with suspected or positive COVID-19 to be referred to COVID-19 care team/nodal officer of hospital COVID unit in designated hospitals Dedicated COVID hospital Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
COVID Positive patients Dialysis COVID Positive patients Dialysis Suspected or positive COVID-19 be dialyzed in isolation Ideally in a separate room with a closed door, if possible Next most suitable option is using a separate shift, preferably end of day Next option, positive or suspected patient to be dialyzed at row end within the unit ensuring separation from all other patients by at least 2 metres, with a demarcated physical temporary partition Staff caring for suspected or proved cases shall not look after other patients during the same shift Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
PPE PPE As per MoHFW PPE guidelines MoHFW, DGHS, EMR. 1 May 2020. Novel Coronavirus Disease 2019 (COVID-19): Additional guidelines on rational use of Personal Protective Equipment (setting approach for health functionaries working in non- COVID areas) MoHFW, DGHS, EMR. April 2020. Novel Coronavirus Disease 2019 (COVID-19): Guidelines on rational use of Personal Protective Equipment
Disinfection practices in dialysis unit Disinfection practices in dialysis unit Disinfectants as per Government guidelines and machine manufacturer s instructions Bed-side dialysis in the hospital Portable RO should be properly disinfected with hypochlorite (1% sodium hypochlorite) between use of two patients Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
Peritoneal dialysis Peritoneal dialysis 1. Patients already on CAPD Patients will not be exposed to hospital environment reducing their exposure to infection Used dialysis bags and tubing should be properly disposed using 1% hypochlorite solution first And disposed in a sealed bag; used dialysis fluid should be drained in the flush 2. New patient planned for CAPD Unless the resources are available and the facility is equipped, this can be postponed 3. Acute PD Use of acute peritoneal dialysis can be lifesaving and should be used as and when required and, in the setting, where haemodialysis facility is not available Use all precautions while initiating acute PD and discard used consumables as per BMW regulations Government of India, MoHFW, April 2020. Revised Guidelines for Dialysis of COVID-19 patients
COVID and IPC in Labour Room COVID and IPC in Labour Room
General principles General principles Separate isolation of pregnant women who have confirmed COVID- 19 or suspects Basic and refresher training for all healthcare personnel PPE supplies at all points of care, as per MoHFW guidelines Processes to protect new-born from risk of COVID-19 ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Effect of COVID Effect of COVID- -19 on Pregnancy 19 on Pregnancy Pregnant women not more likely to contract the infection than general population Cases of COVID-19 pneumonia in pregnancy are milder with good recovery In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase during the last trimester of pregnancy Case reports of preterm birth in women with COVID-19 but data insufficient Pregnant women with heart disease are at highest risk Higher risk of perinatal anxiety and depression, as well as psychological effects and domestic violence ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Transmission Transmission Vertical transmission in the labour room transmission from mother to baby antenatally or intrapartum currently insufficient evidence Currently, no data on Vaginal secretions being positive for COVID-19, or Breast milk being positive for COVID-19 ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Effect on fetus Effect on fetus Currently no data suggesting higher risk of miscarriage or early pregnancy loss in relation to COVID-19 No conclusive evidence that SARS-CoV-2 is teratogenic; long term data awaited ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Screening pregnant women presenting to LR Screening pregnant women presenting to LR All pregnant women to be screened and segregated based on: Detailed (travel) history History of exposure to people with symptoms of COVID-19 Symptoms of COVID-19 Coming from hot-spot area Immunocompromised status ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Dos and donts for Obstetric care providers Do s and don ts for Obstetric care providers If a woman meets criteria for COVID-19 testing, she should be tested Obstetric management should not be delayed awaiting COVID-19 testing Elective procedures like induction of labour for indications that are not strictly necessary, is Obstetrician s choice If ultrasound equipment and fetal monitoring equipment is used it should be decontaminated/disinfected after use ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Care in Labour Care in Labour Mode of birth should not be influenced by the presence of COVID-19, excepting clinical urgency No evidence that epidural or spinal analgesia or anaesthesia is contraindicated in the presence of coronaviruses, it minimizes infection risk In case of deterioration in the woman s symptoms, individual assessment should guide the mode of delivery When caesarean or other operative procedure is advised, it should be done after wearing full PPE All equipment should be protected with disposable covers and disinfected after procedures are over ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
OB OB- -GYN GYN Emergency Theatre Emergency Theatre Elective obstetric procedures (e.g. cervical cerclage or caesarean) should be scheduled at end of the operating list or in a dedicated theatre Non-elective procedures should be carried out in a second obstetric theatre, where available, allowing time for a full post-operative theatre disinfection Number of staff in the operating theatre should be kept to a minimum, and all must wear appropriate PPE; circulating staff should be kept away ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Postnatal IPC Postnatal IPC Unknown whether new-born with COVID-19 are at increased risk for severe complications Transmission after birth via contact with infectious respiratory secretions is a concern Consider temporarily separating (separate rooms) the mother who is confirmed COVID-19 or suspect, from her baby until mother s transmission-based precautions are discontinued ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Considerations for temporary separation Considerations for temporary separation Separate isolation room should be available for the infant while they remain a suspect If co-location ( rooming in ) of the new-born with his/her ill mother in the same hospital room occurs, facilities should consider implementing measures to reduce exposure of the new-born Consider engineering controls like physical barriers (e.g. curtain between the mother and new-born) and keeping the new-born at least 1 metre away from the ill mother If no other healthy adult is present in the room to care for the new-born, a mother who has confirmed COVID-19 or is a suspect should put on a facemask and practice hand hygiene before each feeding or other close contact with her new-born Facemask should remain in place during contact with the new-born ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
Breastfeeding Breastfeeding During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply Dedicated breast pump should be provided Prior to expressing breast milk, mothers should practice hand hygiene After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected as per the manufacturer s instructions Expressed breast milk should be fed to the new-born by a healthy caregiver taking contact precautions If a mother and new-born do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding ICMR-NIRRH, April 2020. Guidance for Management of Pregnant Women in COVID-19 Pandemic
