>> Welcome to the third segment of the Frontline Staff Toolkit
for Outpatient Hemodialysis Facilities.
This toolkit was created as a resource for frontline staff
who are having frequent interactions and providing direct care
in outpatient hemodialysis facilities.
It includes short video slide decks intended to be used as educational resources.
They can be viewed as a group, or individually as time allows.
Evidence-based practices and existing CDC guidance for preventing infections
in the dialysis setting, as well as observations
of clinical practices are the foundations for this toolkit.
Coronavirus Disease 2019, COVID-19, recommendations are summarized
in the Interim Additional Guidance for Infection Prevention and Control Recommendations
for patients with suspected or confirmed COVID-19 in outpatient hemodialysis facilities.
This guidance was developed from the information currently available about COVID-19.
This approach will be refined and updated as more information becomes available,
and as response needs change in the United States.
It is important to stay informed about COVID-19 to prevent the introduction
and minimize the spread of COVID-19 in your dialysis facility.
We encourage you to use this toolkit along with other COVID-19 dialysis specific resources
and ongoing activities in your clinic.
The guidance and additional resources are available on CDC's webpage.
The video you are watching today is Tips
for Outpatient Hemodialysis Facilities During COVID-19 Screening and Patient Placement.
The virus that causes COVID-19, SARS Co-V2 is capable of spreading easily in the community.
Community spread, meaning people have been infected with the virus
in an area including some who are not sure how or where they became infected.
There are some areas throughout the country where community spread is happening now.
COVID-19 is a new disease, and we are still learning how it spreads.
To our knowledge, person to person is the main way this disease spreads.
Between people in close contact with one another, about six feet;
through respiratory droplets produced when an infected person speaks, coughs, or sneezes.
These droplets can land in the mouths or noses of people who are nearby,
or possibly be inhaled into the lungs.
Some recent studies have suggested that COVID-19 may be spread
by people who are not showing symptoms.
The other way it may spread is through contact with contaminated surfaces or objects.
It may be possible to get COVID-19 by touching surfaces
and by touching your mouth, nose or eyes.
To limit the spread of COVID-19, it is important to promptly identify and separate patients
who are ill, and to implement universal source control measures.
Source control which involves having the infected person wear a cloth face covering
or face mask over their mouth and nose
to contain their respiratory secretions might help reduce the risk
of transmission of SARS/Co-V2.
Recent studies indicate that people who are infected, but do not have symptoms,
likely play a role in the spread of COVID-19.
For this reason, everyone, healthcare personnel and patients, should wear a cloth face covering
or face mask while in the dialysis facility regardless of symptoms.
It is also important to maintain a safe distance, at least six feet,
between both patients and staff as much as possible.
You heard a lot about personal protective equipment, or PPE, in video 2
but it is important to remember that cloth face coverings are not considered PPE,
and should not be used by healthcare personnel when more than source control is needed.
Screening or triaging patients before they enter the facility reduces exposures
for other patients and healthcare personnel, helps prevent the spread of disease
within the facility and helps ensure PPE is used effectively.
While the process will depend on your facility layout and staffing, let's cover some basics,
and review a few important steps to remember.
Triaging or screening dialysis patients for signs and symptoms of COVID-19 is essential
to help prevent the spread of infections.
A multi-step screening process should be in place
to ensure patients with symptoms are not missed.
Step one. Screening and triage before patient arrival at the clinic.
Have a staff member call patients before their next treatment to ask them
if they have any symptoms of COVID-19 such as fever, new cough, sore throat,
tiredness or shortness of breath.
Make sure patients know how to notify the facility if they develop these symptoms.
Consider using automated communication to remind patients about reporting symptoms.
For example, some electronic medical records have the ability to easily send emails
or text reminders or personalized messages to patients.
Advise patients to check their temperature at home before leaving for dialysis,
and to put on a cloth face covering regardless of symptoms before leaving their home.
Having advanced notice of symptoms will allow your facility time to prepare
for the patient's arrival, or if indicated based on symptoms,
to refer them to a higher level of care.
Step two in the process is arrival at the clinic.
All patients will be asked if they have a fever or symptoms of COVID-19 such as new cough,
sore throat, tiredness or shortness of breath, immediately upon arrival at the clinic.
Place a staff member near all entrances, outdoors if weather and facility layout permit,
or in the waiting room area to ensure patients are screened before entering the
treatment floor.
Screening can be completed in two different ways.
Defined by how much separation the staff have from the patients being screened.
The first way would be that staff administers screening questionnaires remaining
at least six feet from the patient or separated from patients by a physical barrier.
Screening staff should wear a face mask or cloth face covering for source control,
but do not need to wear PPE if they are separated from patients by a physical barrier
such as glass or plastic window, or they're at least six feet away.
Screening staff should make these interactions as brief as possible,
and limit the interaction to screening questions only.
Alternatively, staff may be performing direct evaluations, such as temperature checks
that require them to be within six feet of a patient.
If there is widespread community transmission of COVID-19,
facilities should consider instituting active temperature monitoring
by having a staff member check the patient's temperature immediately upon arrival
at the door, and when the patient is first asked about symptoms.
Staff within six feet of the patient who may be performing these types
of direct evaluations should use appropriate PPE, including an N95 or higher level respirator
or face mask if a respirator is not available, gloves and eye protection.
Equipment, such as thermometers, should be disinfected between uses.
If patients are not already wearing a cloth face covering or face mask, provide one.
Take this opportunity to educate patients on proper placement of a mask,
and instruct them to leave it on the entire time they are in the dialysis facility.
Step three.
After screening.
Sending patients to their appropriate waiting areas.
If a patient needs urgent care, though, for any condition, including COVID-19,
immediately notify a healthcare provider about the need for further clinical management
to determine if a higher level of care is necessary.
Patients with symptoms should be directed to a separate waiting area for symptomatic patients,
at least six feet away from the area for patients without symptoms, or be allowed to wait
in their personal vehicle until their treatment time if clinically stable.
Within the waiting area, patients should be separated by at least six feet.
Notify direct patient care staff of the presence of a symptomatic patient,
and take the patient back to the appropriate treatment area as soon as possible.
If no fever or other symptoms are noted, direct the patient to a waiting area for patients
without symptoms in which they should also be separated by at least six feet,
and ensure all patients continue to wear a cloth face covering
or face mask while in the facility.
Again, if the patient is not already wearing their cloth face covering,
a face mask should be offered if supplies allow.
Don't forget to disinfect waiting rooms regularly.
Immediately after departure of the symptomatic patient from the waiting area,
disinfect surfaces that were within six feet of the symptomatic patient.
All waiting areas need to be cleaned,
including those for both symptomatic and asymptomatic patients.
Consider assigning a staff member to clean and disinfect all surfaces
of both waiting areas on a set schedule.
For example, after each dialysis treatment shift.
Remember, items that cannot be disinfected such as magazines
and other paper materials should remain with the patient or be discarded.
As mentioned multiple times throughout this video,
patients with symptoms should be wearing a cloth face covering or face mask,
and brought to their designated treatment area as soon as possible.
Where symptomatic patients are placed for treatment will vary from facility to facility.
Ideally, ill patients will be in a separate room with the door closed.
However, if more than one symptomatic patient is present on a single shift,
it makes it less likely that this is an option.
If a separate room is not available, treatment will be at a corner
or end of row station away from the main flow of traffic.
Patients should be separated by at least six feet from the nearest patient in all directions,
and again, patients should wear their cloth face covering or face mask for the entire treatment.
Remember that hepatitis-B isolation rooms should only be used if the facility has no patients
with hep-B infections that would otherwise need that room.
Also of note, if the patient is unable to tolerate a cloth face covering or face mask,
they should be six feet from the nearest patient station in all directions
and six feet from the nearest patient.
You may see changes in the day-to-day operation at your facility.
Patients with respiratory infections might be grouped or cohorted in the same section
of the unit and/or the same shift of the day.
Patients with different respiratory infections should not be grouped.
For example, a patient with influenza should not be grouped with the patient with COVID-19.
Suspected or confirmed COVID-19 cases may be grouped during their treatment.
In some areas with widespread community transmission, facilities might be designated
to care just for patients with COVID-19.
Some units are also adding an extra fourth shift for confirmed COVID patients.
Even if grouped or cohorted on the same shift,
suspected and confirmed COVID-19 patients should be kept six feet apart.
If suspected and confirmed COVID-19 patients will be cohorted together,
it is particularly important to change PPE and perform hand hygiene
when moving between these groups.
The staff taking care of these patients may also be dedicated and grouped.
And your facility should have a plan to minimize the number of staff
who enter the isolation dialysis room or isolation stations.
The guidance reviewed today,
as well as additional CDC resources are available on the CDC website.
This slide lists a few links that you may find helpful.
This is an emerging, rapidly-evolving situation and CDC will provide updated information
as it becomes available, in addition to updating guidance on its website.
Thank you for watching this module and thank you for your work to keep patients on dialysis safe.