Yeung Angie, Aziz Anas, Taji Leena, Cooper Rebecca, Oliver Matthew J, Blake Peter G, McFarlane Phil
Ontario Renal Network, Ontario Health, Toronto, Canada.
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Can J Kidney Health Dis. 2023 Jan 12;10:20543581221146033. doi: 10.1177/20543581221146033. eCollection 2023.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that caused coronavirus disease 2019 (COVID-19), the multisystem disease central to the COVID-19 pandemic. As patients receiving in-center maintenance hemodialysis require treatment 3 times weekly, they were unable to fully isolate. It was important for in-center hemodialysis units to implement robust infection control practices to ensure patient safety and minimize risk of transmitting SARS-CoV-2 among patients and staff. There are 27 renal programs within Ontario, Canada, providing care for about 9000 people across about 100 in-center hemodialysis units. These units are funded by the Ontario Renal Network (ORN), which is part of the provincial agency Ontario Health.
The objective was to track infection control practices that were implemented by in-center hemodialysis units and be able to provide a descriptive narrative of the COVID-19 pandemic response of Ontario's hemodialysis units between March and September 2020.
Between May and September 2020, data were collected from Ontario's 27 renal programs on the implementation of key infection control practices, including symptom screening, use of personal protective equipment, testing, practices specifically related to patients from congregate living settings, other prevention practices, and outbreak management. There were 4 data collection cycles, each approximately 1 month apart. The results were compiled and shared across the province, and infection control practices were also discussed at provincial COVID-19 teleconferences hosted by the ORN.
By March 2020, all but one renal program had implemented one or more forms of symptom screening, all renal programs had implemented physical distancing in waiting rooms and restricted visitors, and 74% of renal programs had implemented universal masking for all staff. By April 2020, 89% of renal programs had implemented universal masking for all patients, 52% had implemented enhanced contact and droplet precautions for suspected or positive cases, and 59% of renal programs tested all patients from congregate living settings regularly (with a low symptom threshold for testing). Infection control practices became more homogeneous across renal programs over time, and most practices were in place as of the last data collection.
The renal system in Ontario was able to respond quickly within the first 2 months of the pandemic to minimize the spread of COVID-19 within in-center hemodialysis units. Through provincial teleconferences, infection control practices were shared across the province as the pandemic and hemodialysis unit responses evolved. This supported renal programs to advocate locally if their hospital was lagging in practices felt to be of value in other hemodialysis units. Although no direct correlation can be made regarding the implementation of infection control practices within in-center hemodialysis units and the number of COVID-19 cases in this population, the limited number of outbreaks in hemodialysis units may have been influenced by the proactive response of renal programs. Practices described in this article may support management and response to subsequent waves of COVID-19 or future similar infectious diseases.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种引发2019冠状病毒病（COVID-19）的病毒，COVID-19是COVID-19大流行的核心多系统疾病。由于接受中心内维持性血液透析的患者每周需要进行3次治疗，他们无法完全隔离。中心内血液透析单位实施强有力的感染控制措施对于确保患者安全以及将SARS-CoV-2在患者和工作人员之间传播的风险降至最低至关重要。加拿大安大略省有27个肾脏项目，通过约100个中心内血液透析单位为约9000人提供护理。这些单位由安大略省肾脏网络（ORN）资助，ORN是省级机构安大略省卫生厅的一部分。
目的是追踪中心内血液透析单位实施的感染控制措施，并能够对安大略省血液透析单位在2020年3月至9月期间对COVID-19大流行的应对情况进行描述性叙述。
2020年5月至9月期间，从安大略省的27个肾脏项目收集了关于关键感染控制措施实施情况的数据，包括症状筛查、个人防护装备的使用、检测、与集体生活环境患者相关的具体措施、其他预防措施以及疫情管理。有4个数据收集周期，每个周期相隔约1个月。结果进行了汇总并在全省范围内共享，感染控制措施也在ORN主办的省级COVID-19电话会议上进行了讨论。
到2020年3月，除一个肾脏项目外，所有项目都实施了一种或多种形式的症状筛查，所有肾脏项目都在候诊室实施了物理距离措施并限制访客，74%的肾脏项目对所有工作人员实施了普遍佩戴口罩。到2020年4月，89%的肾脏项目对所有患者实施了普遍佩戴口罩，52%的项目对疑似或确诊病例实施了强化接触和飞沫预防措施，59%的肾脏项目定期对来自集体生活环境的所有患者进行检测（检测症状阈值较低）。随着时间的推移，各肾脏项目的感染控制措施变得更加统一，截至最后一次数据收集时，大多数措施都已到位。
安大略省的肾脏系统能够在大流行的前两个月内迅速做出反应，以尽量减少COVID-19在中心内血液透析单位的传播。随着大流行和血液透析单位应对措施的演变，通过省级电话会议在全省范围内分享了感染控制措施。这支持了肾脏项目在其医院在被认为对其他血液透析单位有价值的措施方面滞后时进行本地倡导。尽管无法直接将中心内血液透析单位感染控制措施的实施与该人群中COVID-19病例的数量联系起来，但血液透析单位有限的疫情可能受到了肾脏项目积极应对的影响。本文所述的措施可能有助于管理和应对COVID-19的后续浪潮或未来类似的传染病。
