Inside Pediatrics, Nephrology

Managing COVID-19 in the Dialysis Unit

When COVID-19 hit in early March, hospitals, including Children’s of Alabama, pivoted to telehealth appointments and canceled non-urgent procedures. But that’s not an option for children who need dialysis, particularly since Children’s is the only hospital in Alabama providing pediatric dialysis.

“We were running at full staff and operating as usual,” said Suzanne White, dialysis director at Children’s renal care center. That meant seeing hemodialysis patients three times a week, home dialysis patients once a month, and implementing protocols to reduce the risk of infection to patients and staff. It also meant that even if a patient tested positive for COVID-19, they still had to come to the hospital for dialysis. “You can’t reschedule dialysis if you have COVID,” said Sahar Fathallah-Shaykh, M.D., a pediatric nephrologist at Children’s and the University of Alabama at Birmingham (UAB). The task was made more challenging as with kidney transplants on hold, the dialysis center was seeing twice as many patients.

Among the changes the unit implemented:

  • Moving hemodialysis patients to peritoneal (home) dialysis whenever possible to limit visits to the hospital. This posed its own challenges, including training family members and coordinating with surgeons. “We did more peritoneal dialysis surgeries in those early months than we had done in years,” Fathallah-Shaykh said.
  • Limiting visitors in the unit. “We could accommodate eight patients at one time but we couldn’t have people gathering,” White said.” That meant families calling from the parking lot when they arrived, mask wearing, initial screening when they entered the hospital, and more advanced screening before they entered the dialysis unit. We drilled down to avoid screening fatigue,” she said.
  • Extensive education with families about COVID-19 and risk mitigation. “We had to make sure they realized the impact of this illness,” Fathallah-Shaykh said.
  • Treating COVID-positive patients in an isolation room when the unit was empty and implementing a special deep cleaning process.

“We were diligent because we knew what the illness could cause,” White said. The team was particularly concerned about the staff. Dialysis nurses require extensive training, and there are few available if one becomes sick. “If several got sick, it would be a disaster,” Fathallah-Shaykh said. In the end, just four staff and four patients tested positive, all community acquired. And, Fathallah-Shaykh stressed, “We never relaxed our standards. We added COVID to our high standard of care; we didn’t adjust our standard of care for COVID.”

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