Evaluation of Prevention, Mitigation, and Containment Measures of Infection With SARS-CoV-2 at 10 Egyptian Governmental Hemodialysis Units, 2020–2021

Respiratory Diseases
Healthcare related infections

Background: Dialysis patients are at high risk for severe prognosis of SARS-CoV-2 infection due to clustering of patients and close contact with nursing staff. Studies reported 5.7%–19.9% incidence and 0.0%–30.5% death rate from SARS-CoV-2 at hemodialysis units. In this retrospective study, we report incidence and outcome of SARS-CoV-2 from March 2020–August 2021 and evaluate preventive measures to limit infection transmission at 10 governmental hemodialysis units.
Methods: Patients' data were extracted from hospital records using pre-designed checklist that include patients’ demographics, PCR testing results, and outcome. Evaluation of 110 nurses’ compliance to the Egyptian guidelines for prevention, mitigation, and containment of SARS-CoV-2 infection at hemodialysis units is regularly performed by hospital supervisors. Observation with a checklist is used, scores are given to different procedures and converted to percents of total to determine level of compliance with >75% considered good and 50%–75% considered fair compliance. Correlation was performed to examine the relation between level of compliance and attack rates.
Results: Of 1,647 patients who underwent hemodialysis during the study period, 233 (14.1%) had SARS-CoV-2, including 108 (46.4%) from 2 units. Of all SARS-CoV-2 patients, 54 (23.2%) were admitted to ICUs and 39 (16.7%) died at the hospital. Overall compliance to preventive measures was 59.8%, ranging from 41.4%–83.6%. The highest compliance levels were in linen handling, using aseptic technique, and infection control policy (79.5%, 72.3%, and 71.9%, respectively), while the least compliance was observed in hand hygiene, using PPEs, and environmental cleaning (38.5%, 41.7%, and 46.3%, respectively). The level of compliance was negatively correlated with attack rates at each dialysis unit (r=-0.535).
Conclusions: Our study showed moderate attack and case fatality rates from SARS-CoV-2 at 10 governmental dialysis units in Egypt. Fair compliance to preventive measures that differ by unit was observed. Improved compliance of hand hygiene and PPEs use is recommended to reduce attack and case fatality rate from SARS-CoV-2.

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