There are approximately 700,000 hemodialysis (HD)-dependent ESRD patients in mainland China.During the epidemic of novel coronavirus pneumonia, patients on HD are at high risk of infection. These patients have to go to the facilities for treatments 2 to 3 times a week with each treatment period 4 to 5 hours. Most patients need to take public transportation, which makes them a special “mobile population” in the city. More importantly, these patients are a vulnerable population with low immune function, diabetes, hypertension or other complications. Therefore, it is necessary to strengthen the prevention and management in order to protect HD patients from novel coronavirus infection.
Suggested preventive strategies are as follows:
1. Strengthen disinfection of dialysis facilities and protection of medical staff
a. Patients diagnosed with the novel coronavirus infection should be transferred to the dedicated hospital for dialysis treatment. Patients with an exposure history need to be quarantined for 14 days and should be dialyzed in separate dialysis room during the observation period.
b. Perform environmental disinfection after each shift of dialysis, including window ventilation for 30 minutes; air disinfection with hydrogen peroxide spraying; wiping the floor and surface of dialysis machine with 1000-2000 mg/L chlorinated disinfectant; and replacing bedding.
c. Surfaces and supplies contaminated with patients’ excreta, secretions, or blood should be soaked with 2000mg / L chlorinated disinfectant and cleaned separately.
d. Medical staff need to measure and record their body temperature when entering or leaving the dialysis facility. Those with a temperature above 37.3 ℃ are not allowed to enter the facility and must receive relative management. Staff and their family members who have fever, cough, or flulike symptoms, should be isolated and receive medical management.
e. During routine HD procedure, the medical staff should be protected according to level-1 protective strategies (disposable work caps, disposable surgical masks, disposable latex gloves, disposable shoe covers), and all protective supplies need to be replaced in each case. For deep venous catheterization, disposable surgical gowns and goggles are required.
2. Strengthen the protection for patients on maintenance HD and their family members
a. Register the residential address of patients and their family members, and confirm whether there is epidemic at the location and whether they have contacted with diagnosed patients or suspected cases. The medical staff review these information and repeat the register every two weeks.
b. Monitor the body temperature of dialysis patients and caretakers before they enter the facility. Caretakers are not allowed to enter the dialysis treatment area.
c. Ask dialysis patients to wear masks during dialysis treatment.
d. The facility sets up a call on duty and requires patients to report symptoms such as cough, fatigue, and fever during dialysis intervals to the medical staff on duty, and follow their instructions.
e. Provide preventive education for patients on HD. Let patients understand the importance of prevention and isolation, and know the correct protective strategies. Help patients to overcome their fear of the epidemic.
f. Use APP for medical consultation, follow-up, and regular drug prescription to reduce the requirement of clinic visit.
We are confident that, through the joint effort of medical staff and patients, we will win the fight against the novel coronavirus!
Division of Nephrology, Nanfang Hospital
National Clinical Research Center for Kidney Disease
State Key Laboratory of Organ Failure Research
中文译文如下：血液净化中心防控新型冠状病毒感染的措施
我国有约70万依赖血液透析维持生命的终末期肾脏病患者，在新型冠状病毒肺炎流行期，血透治疗患者是感染新冠病毒的高危人群。这类患者必须每周2至3次到医院或诊所集中进行血透治疗，每次治疗时间约为4至5小时；多数患者需乘坐公共交通工具往返，成为城市特殊的“流动人群”；更为重要的是这类患者多为免疫功能低下、有糖尿病、高血压等多种并发症的易感人群。因此需要加强对医院血透室和血透患者新型冠状病毒感染的防控，以防止这部分人群发生感染并造成疫情扩散。 南方医院血液净化中心防控新冠病毒感染的措施如下：
一、加强血液透析室消毒和医务人员防护
1、对于确诊的新型冠状病毒感染患者，应转至定点医院接受透析治疗；对有接触史需隔离观察14天的患者，观察期在隔离的透析室接受透析。
2、每轮透析治疗结束后进行环境消毒，包括开窗通风30分钟；过氧化氢喷雾空气消毒；采用 1000-2000mg/L 含氯消毒剂擦拭地面和透析机表面；更换床上用品。
3、沾染患者排泄物、分泌物、血液的物体表面及用品用2000mg/L 含氯消毒剂浸泡处理；污染的床上用品需单独清洁。
4、透析室医务人员上下班进出透析室时均需测量体温并记录，体温≥37.3℃者不得进入透析室并按相关规定就诊，要求工作人员或其家庭成员有发热、咳嗽等症状者及时上报，必要时进行隔离观察。
5、常规血透操作时医护人员执行一级防护措施（一次性工作帽、一次性外科口罩、一次性乳胶手套、一次性鞋套），每例操作需更换全部防护用品。深静脉插管操作需穿一次性外科手术衣，戴护目镜。
二、加强规律性血透患者及其家庭成员的管理
1、登记所有规律性血透患者的户籍所在地，患者及家庭成员现居住地，了解是否疫源地，有无疫源地人员或新冠病毒确诊者接触史或可疑接触史，由医务人员审核，两周一次重复筛查。
2、对每日前来透析患者及其陪护人员进行体温监测。陪护人员不得进入透析治疗区。
3、要求透析患者在治疗过程中全程佩戴口罩。
4、血液净化中心设立值班电话，要求患者在透析间期出现咳嗽、乏力、及发热等症状及时向值班医务人员报告，并听从指示，及时就诊。
5、对每位患者进行预防宣教，让患者了解预防和隔离的重要性以及正确的预防措施。加强与患者的沟通，克服患者对疫情的恐惧。
6、利用APP等为血透患者提供医疗咨询、随访、开具常用药，以减少患者需到医院门诊的次数和门诊候诊人数。
7、设法减少患者乘坐公共交通工具的次数，如代患者联系志愿者接送等。
隔离病毒，不隔离爱。希望通过医务人员和血透患者的共同努力，早日打赢新冠病毒肺炎防控阻击战！
南方医科大学南方医院肾内科
国家肾脏病临床医学研究中心
国家器官衰竭防治重点实验室