Hendren Elizabeth M, Matthews Nicola, Oliver Mathew, Rice Julie, Tobe Sheldon W, Auguste Bourne L
Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Can J Kidney Health Dis. 2020 Sep 8;7:2054358120957473. doi: 10.1177/2054358120957473. eCollection 2020.
Hemodialysis patients are at significant risk from COVID-19 due to their frequent interaction with the health care system and medical comorbidities. We followed up the trajectory of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre in Toronto. We present the lessons learned and changes in practices that occurred to prevent an outbreak in our center.
The patient, a 66-year-old woman on in-center hemodialysis, initially presented with a 2-day history of a productive cough. She subsequently developed a fever, was placed on contact and droplet isolation, and admitted to hospital.
On March 13, 2020, the patient tested positive for COVID-19. Within the next 48 hours, she developed hypoxia and acute respiratory distress syndrome as a complication of her illness requiring an extended critical care stay. This extended critical care stay resulted in critical illness-associated secondary sclerosing cholangitis.
An interprofessional team was established, performing rapid Plan-Do-Study-Act quality improvement cycles to improve screening practices and promote the safety of patients and staff in the hemodialysis unit.
We present here the lessons learned, the changes to our screening protocols, and the clinical course of our first in-center hemodialysis patient with SARS-CoV-2.
Regular review of the infection screening processes is paramount in preventing outbreaks of COVID-19, particularly in hemodialysis units. Hospital admission should be arranged if a patient exhibits any clinical signs of hemodynamic compromise or hypoxia. Early education for health care practitioners caring for patients with COVID-19 and refresher information regarding personal protective equipment helped promote the safety of staff and prevent health care-associated outbreaks.
血液透析患者由于频繁与医疗系统接触以及存在合并症，感染新冠病毒的风险极高。我们对多伦多桑尼布鲁克健康科学中心首例新冠病毒检测呈阳性的维持性血液透析患者的病程进行了跟踪。我们介绍了所吸取的经验教训以及为防止我们中心爆发疫情而发生的操作变化。
该患者是一名66岁接受中心血液透析的女性，最初表现为有2天咳痰的病史。随后她出现发热，被采取接触和飞沫隔离措施，并被收治入院。
2020年3月13日，该患者新冠病毒检测呈阳性。在接下来的48小时内，她出现缺氧和急性呼吸窘迫综合征，这是其疾病的并发症，需要长时间入住重症监护病房。这次长时间的重症监护导致了与危重症相关的继发性硬化性胆管炎。
成立了一个跨专业团队，开展快速的计划-执行-研究-行动质量改进循环，以改善筛查操作，并提高血液透析单元患者和工作人员的安全性。
我们在此介绍所吸取的经验教训、筛查方案的变化以及我们首例中心血液透析新冠病毒患者的临床病程。
定期审查感染筛查流程对于预防新冠病毒爆发至关重要，尤其是在血液透析单元。如果患者出现任何血流动力学不稳定或缺氧的临床症状，应安排住院治疗。对护理新冠病毒患者的医护人员进行早期教育以及提供有关个人防护装备的复习资料，有助于提高工作人员的安全性并防止医疗相关疫情爆发。
