Abstract
Patients receiving in centre haemodialysis (ICHD) suffer from extremely high mortality rates
from COVID-19. ICHD patients are clinically extremely vulnerable but are unable to selfisolate
as they have to attend hospital facilities three times weekly for life sustaining treatment.
COVID-19 outbreaks in haemodialysis (HD) units are currently a main driver of the excess
mortality in this cohort of patients. Here, we report the results of a quality improvement project
aimed to eliminate outbreaks of COVID-19 in haemodialysis units. We also evaluated the
utility of surveillance nose and throat swab real-time reverse transcription polymerase chain
reaction (rRT-PCR) test and serum antibodies for SARS-CoV-2 for prompt identification and
segregation of patients infected with COVID-19.
Methods
This quality improvement study was conducted on 402 patients receiving maintenance HD at
the Salford Renal Department (main hospital and satellite units) between March 2020 and
December 2020. A multidisciplinary quality improvement (QI) group was formed in June 2020
following the first wave of the pandemic in the North West of England and a multifaceted QI
programme including a bundle of 10 key Infection Prevention Control (IPC) measures was
developed.
The primary outcomes evaluated were the incidence of outbreaks (defined as more than two
cases linked in time and place based on national guidance) in HD units and severe COVID-19
illness defined as COVID-19 related death or hospitalisation. The secondary outcomes
examined included the proportion of positive patients identified in presymptomatic/
asymptomatic phase on surveillance rRT-PCR screening and the incidence and
longevity of SARS-CoV-2 antibody response in ICHD patients.
Results
Following the implementation of the QI project there were no further outbreaks. Pre (April-
July 2020) and post (August- December 2020) implementation comparison showed a reduction
in COVID-19 related mortality and hospitalisation (26 vs 13 events respectively, p <0.001).
A total of 102 (pre 43 vs post 59) patients had a positive SARS-CoV-2 rRT-PCR test between
April and December 2020. Surveillance SARS-CoV-2 rRT-PCR screening identified 39
asymptomatic or pre-symptomatic cases out of a total of 59 rRT-PCR positive patients (39/59,
66%) in the post implementation period. SARS-CoV-2 antibody levels were detected in 72/74
(97%) rRT-PCR positive patients with available antibody testing. Amongst the patients
infected during the first wave with available SARS-CoV-2 antibody testing from August 2020,
96% had detectable antibodies until January 2021 (days from rRT-PCR test to last antibody
testing 245-280).
Conclusions
Systematic implementation of a bundle of IPC measures using QI methodology eliminated
outbreaks in HD facilities and was associated with reduced mortality and hospitalisations from
COVID-19. Surveillance SARS-CoV-2 rRT-PCR is essential in early detection and isolation
of positive cases. HD patients mount an antibody response to COVID-19 and the vast majority
sustain detectable antibody response for over eight months.
from COVID-19. ICHD patients are clinically extremely vulnerable but are unable to selfisolate
as they have to attend hospital facilities three times weekly for life sustaining treatment.
COVID-19 outbreaks in haemodialysis (HD) units are currently a main driver of the excess
mortality in this cohort of patients. Here, we report the results of a quality improvement project
aimed to eliminate outbreaks of COVID-19 in haemodialysis units. We also evaluated the
utility of surveillance nose and throat swab real-time reverse transcription polymerase chain
reaction (rRT-PCR) test and serum antibodies for SARS-CoV-2 for prompt identification and
segregation of patients infected with COVID-19.
Methods
This quality improvement study was conducted on 402 patients receiving maintenance HD at
the Salford Renal Department (main hospital and satellite units) between March 2020 and
December 2020. A multidisciplinary quality improvement (QI) group was formed in June 2020
following the first wave of the pandemic in the North West of England and a multifaceted QI
programme including a bundle of 10 key Infection Prevention Control (IPC) measures was
developed.
The primary outcomes evaluated were the incidence of outbreaks (defined as more than two
cases linked in time and place based on national guidance) in HD units and severe COVID-19
illness defined as COVID-19 related death or hospitalisation. The secondary outcomes
examined included the proportion of positive patients identified in presymptomatic/
asymptomatic phase on surveillance rRT-PCR screening and the incidence and
longevity of SARS-CoV-2 antibody response in ICHD patients.
Results
Following the implementation of the QI project there were no further outbreaks. Pre (April-
July 2020) and post (August- December 2020) implementation comparison showed a reduction
in COVID-19 related mortality and hospitalisation (26 vs 13 events respectively, p <0.001).
A total of 102 (pre 43 vs post 59) patients had a positive SARS-CoV-2 rRT-PCR test between
April and December 2020. Surveillance SARS-CoV-2 rRT-PCR screening identified 39
asymptomatic or pre-symptomatic cases out of a total of 59 rRT-PCR positive patients (39/59,
66%) in the post implementation period. SARS-CoV-2 antibody levels were detected in 72/74
(97%) rRT-PCR positive patients with available antibody testing. Amongst the patients
infected during the first wave with available SARS-CoV-2 antibody testing from August 2020,
96% had detectable antibodies until January 2021 (days from rRT-PCR test to last antibody
testing 245-280).
Conclusions
Systematic implementation of a bundle of IPC measures using QI methodology eliminated
outbreaks in HD facilities and was associated with reduced mortality and hospitalisations from
COVID-19. Surveillance SARS-CoV-2 rRT-PCR is essential in early detection and isolation
of positive cases. HD patients mount an antibody response to COVID-19 and the vast majority
sustain detectable antibody response for over eight months.
| Original language | English |
|---|---|
| Journal | Nephron |
| Publication status | Published - 2021 |