Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Subject Characteristics
2.2. Formation of COVID-19 Joint Rapid Response Team
2.3. Specific Preventive Strategies in HD Center of Chang Gung Memorial Hospital at Keelung
2.4. Adjustment of Preventive Measures According to Reproduction Number (Rt)
2.5. Laboratory Confirmation for SARS-CoV-2 Infection: Rapid Antigen Test and RT-PCR Analysis
2.6. Data Source of Local and National Burden
2.7. Statistical Analyses
3. Results
3.1. Study Subject Characteristics
3.2. An Overview of the Pandemic in Northern Taiwan in the First Month of Outbreak
3.3. Outcomes of Strict Implementation of Specific Preventive Strategies in HD Unit
3.4. Outcomes of COVID-19 Confirmed HD Patients
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All HD Patients (n = 497) | |
---|---|
Male, n (%) | 263 (53) |
Age, year | 66.03 ± 13.28 |
White blood cell count (×1000/uL) | 6.62 ± 2.87 |
Hemoglobin (g/dL) | 10.06 ± 1.25 |
Platelet (×1000/uL) | 190.47 ± 68.53 |
Albumin (g/dL) | 4.00 ± 0.48 |
Aspartate transaminase (IU/L) | 18.49 ± 10.31 |
Alanine aminotransferase (IU/L) | 17.87 ± 14.74 |
Alkaline-P (IU/L) | 92 (71–137) * |
Total bilirubin (mg/dL) | 0.38 ± 0.16 |
Cholesterol (mg/dL) | 153.76 ± 36.27 |
Triglyceride (mg/dL) | 151.77 ± 116.22 |
Creatinine (mg/dL) | 9.40 ± 2.68 |
Uric acid (mg/dL) | 6.43 ± 1.82 |
Na (meq/L) | 138.10 ± 3.21 |
K (meq/L) | 4.70 ± 0.83 |
Ca (mg/dL) | 9.33 ± 0.90 |
P (mg/dL) | 5.26 ± 1.55 |
Kt/V (Daugirdes) | 1.67 ± 0.33 |
Normalized protein catabolic rate (g/kg/day) | 1.08 ± 0.39 |
Ferritin (ng/mL) | 496.46 ± 415.14 |
Transferrin saturation (%) | 33.00 ± 14.51 |
Intact-parathyroid hormone (pg/mL) | 285 (119, 672) * |
Cardiac/thoracic ratio | 0.52 ± 0.07 |
Ca × P product | 49.17 ± 15.67 |
Districts | Confirmed Cases | Total Population # | Incidence Rate (%) |
---|---|---|---|
National | 14,804 | 23,816,775 | 0.062 |
Taipei City | 4470 | 2,581,006 | 0.173 |
New Taipei City | 6503 | 4,027,730 | 0.161 |
Keelung City | 303 | 367,088 | 0.083 |
Overall HD patients at Keelung | 9 | 1351 | 0.666 |
CGMH-HDR * | 0 * | 497 | 0.000 |
Strategies | Contents of Measures |
---|---|
Space segmentation | Use of solid compartment to separate the open room into cabins of 8–10 beds, using wood, strengthened glass, and acrylic as materials. Use of acrylic partitions in the nursing station to limit droplet dissemination. Fixed care bundle: fixed patients and caregivers in pre-established bed or seat location cared by a fixed nursing team using fixed clinical carts. Installation of monitoring and loudspeaker system in negative pressure isolation room to limit frequent entries and exits of personnel. |
Access control | Spacing between exchanges of HD sessions to avoid overlapping of patients at entry and exit of HD room. Double TOCC checking at both entry of hospital (by reading of NHI card) and at the door of HD unit (by personal verbal and written confirmation). Double-checking of clinical symptom and body temperature at both entry of hospital and at the door of HD unit. Double hand alcohol disinfection at both entry of hospital and at door of HD unit. Remove tables and chairs in the waiting area and set up a position mark on the ground of entry with 1.5 m of distancing to avoid clustering. Control of the total number of people in the hospital and in a single elevator. |
Quarantine operations | Postering and broadcasting (at entry of HD room, in the beginning of every HD session) of our HD preventive measures. Caregiver limitation (do not stay in treatment area, or fixed caregiver if assistance needed) |
Weekly rapid nasopharyngeal swab SARS-CoV-2 antigen testing for patients and fixed caregivers. Acceptance of new patients into our HD unit is prohibited during an outbreak. Triage algorithm should be followed for emergent cases (see Figure 3). Bedside vaccination program for all HD patients. | |
Staff protection | All medical and nursing staff wore high-quality PPE, including face shields, goggles, N95 masks, gloves, and waterproof isolation gowns. Staff entering the dialysis room must perform a QR code scan to confirm location and contact tracking. |
Provide the first dose of COVID-19 vaccine to all of the staff before the end of May. Staff who take care of confirmed patients should receive RT-PCR testing on a weekly basis. |
Total Patients (n = 8) * | Alive (n = 3) $ | Deceased (n = 5) | p-Value | |
---|---|---|---|---|
Male, n (%) | 3 (37.5) | 1 (33.3) | 2 (40) | 0.714 |
Age, year | 68.9 (60.88–97.00) | 63.1 (60.88–64.30) | 74.9 (61–97) | 0.143 |
W.B.C. (×1000/uL) | 4.20 (1.00–6.80) | 5.30 (3.30–6.80) | 4.20 (1.00–5.00) | 0.250 |
Hb (g/dL) | 9.55 (7.60–12.40) | 8.20 (7.60–12.40) | 10.5 (8.4–10.8) | 0.571 |
Platelet (×1000/uL) | 125 (39–225) | 155 (76–173) | 103 (39–225) | 0.571 |
Albumin (gm/dL) | 3.66 (3.06–4.15) | 3.76 (3.27–3.91) | 3.56 (3.06–4.15) | 1.000 |
AST (IU/L) | 25 (16–67) | 26 (16–61) | 24 (20–67) | 1.000 |
ALT (IU/L) | 17 (9–34) | 31 (17–34) | 12.5 (9–18) | 0.114 |
Alkaline-P (IU/L) | 110 (48–154) | 128 (48–154) | 110 (69–110) | 0.700 |
Total Bilirubin (mg/dL) | 0.35 (0.3–0.6) | 0.3 (0.3–0.4) | 0.4 (0.3–0.6) | 0.393 |
Cardiac/thoracic ratio | 0.59 (0.48–0.65) | 0.55 (0.48–0.57) | 0.61 (0.58–0.65) | 0.036 * |
Creatinine (mg/dL) | 9.04 (4.00–15.18) | 9.04 (6.39–11.74) | 7.45 (4–15.18) | 0.857 |
Na (meq/L) | 137.5 (121–141) | 138 (137–139) | 135 (121–141) | 0.393 |
K (meq/L) | 3.70 (3.2–6.9) | 4.60 (3.20–5.70) | 3.70 (3.4–6.90) | 1.000 |
Ca (mg/dL) | 8.90 (8.50–11.10) | 9.95 (8.8–11.10) | 8.9 (8.5–10.0) | 0.571 |
P (mg/dL) | 5.00 (2.00–9.90) | 4.40 (2.8–6.0) | 5.0 (2.0–9.9) | 1.000 |
Ferritin (ng/mL) | 869.5 (41.9–6954.0) | 877.0 (41.9–1100.0) | 862.0 (82.3–6954.0) | 0.786 |
Ca × P product | 38.54 (20–88.11) | NA (31.08–52.80) | 46.00 (20.00–88.11) | 0.571 |
Ct value | 17.50 (11.75–27.10) | 17.53 (11.75–27.10) | 17.47 (16.75–18.57) | 1.000 |
CRP (mg/L) | 36.62 (15.17–70.79) | 17.2 (15.17–35.70) | 52.81 (20.60–70.79) | 0.071 |
LDH (U/L) | 249 (185–355) | 249 (185–355) | 243.5 (219.0–290.0) | 1.000 |
Lactate (mg/dL) | 46.35 (7.80–116.60) | 11.05 (7.80–14.30) | 97.5 (78.40–116.60) | 0.333 |
Procalcitonin (ng/mL) | 0.535 (0.16–1.75) | 0.51 (0.16–0.56) | 0.56 (0.48–1.75) | 0.393 |
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Chen, C.-Y.; Ye, J.-J.; Huang, T.-S.; Lee, C.-C.; Chen, Y.-T.; Hsu, C.-K.; Hsu, H.-J.; Sun, C.-Y.; Pan, H.-C.; Chen, K.-S.; et al. Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan. Healthcare 2021, 9, 1173. https://doi.org/10.3390/healthcare9091173
Chen C-Y, Ye J-J, Huang T-S, Lee C-C, Chen Y-T, Hsu C-K, Hsu H-J, Sun C-Y, Pan H-C, Chen K-S, et al. Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan. Healthcare. 2021; 9(9):1173. https://doi.org/10.3390/healthcare9091173
Chicago/Turabian StyleChen, Chun-Yu, Jung-Jr Ye, Ting-Shuo Huang, Chin-Chan Lee, Yih-Ting Chen, Cheng-Kai Hsu, Heng-Jung Hsu, Chiao-Yin Sun, Heng-Chih Pan, Kuo-Su Chen, and et al. 2021. "Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan" Healthcare 9, no. 9: 1173. https://doi.org/10.3390/healthcare9091173