November 08, 2022
Danilo B. Concepcion, CBNT, CCHT-A, FNKF
Prior to the COVID-19 pandemic, the infection control requirements for dialysis to prevent cross-contamination were already well in place as a requirement from the CDC and the ESRD Conditions for Coverage. Dialysis precautions required that items should not be shared from patient-to-patient, proper PPE to protect eyes and face must be worn, practicing hand hygiene, environmental disinfection after station vacancy, and space segregation between patients. What needed to be enhanced was to supplement and expand the typical pre-dialysis screening of weight and temperature with the addition of pre-screening for COVID-19 symptoms, areas of travel outside of the locality, possible exposure to family members or individuals with COVID-19 as examples.
Facilities needed to adjust to the frequent, and sometimes sudden, changes to the COVID response requirement from the CDC. Policies and procedures implemented to segregate patients that were positive for COVID from patients that were PUI (Person Under Investigation) and from the general population in the facility were an extreme challenge. Several changes occurred that altered the patient schedule, operating times, and staff schedules to accommodate the segregation. Social distancing impacted the patient waiting lobby and interfered with social interactions between patients and visitors. In some facilities, patients had to wait in their vehicles until instructed by the facility staff to enter.
The increased demand for gloves, masks, and shields by the public sector and the health community burdened the supply chain. At some points, the CDC recommended strategies to conserve PPE such as the reuse of masks. Staff shortages because of COVID-19 cases and/or the vaccinated/unvaccinated restrictions required facilities to work smarter with less. Issues with dialysis supply manufacturers resulted in some facilities experiencing back orders of critical items such as concentrate jeopardizing the daily ability of facilities to provide the dialysis treatment.
These brief but incomplete summaries of the events COVID-19 created, and how the community reacted dramatically demonstrated the resiliency of patients, staff, and the renal community. Patients adjusted and understood the need to be flexible with their schedules. Staff worked through compassion fatigue, burnout, staff shortages, and facility closures. With collaboration, facilities unable to accommodate treating COVID-positive patients were able to admit patients to neighboring dialysis units that were established to be a “central location” to cohort dialysis patients with COVID. Government and state agencies established waivers to allow for suspensions of reporting certain data, on-site surveys, and staff compliance for renewal of professional certification. Organizations such as the ASN, RHA, Making Dialysis Safer Coalition, NKF, NANT rallied to ensure the community had resources and tools to help in dealing with the COVID pandemic.
It makes me feel proud to know that I’m part of the Interdisciplinary team of Nephrologists, Nurses, Social Workers, Dietitians, Technicians, and all within the Renal Community who have demonstrated the ability and commitment to be flexible and to adjust to adverse and challenging times. The focus on the health, well-being, and needs of our patients has, is, and will always be, our calling and our goal.
