Abstract
Background: Patients receiving in-centre haemodialysis (ICHD) are highly vulnerable to COVID-19.
Objective: We created a quality improvement (QI) project aimed to eliminate outbreaks of COVID-19 in haemodialysis units and evaluated the utility of surveillance rRT-PCR test and SARS-CoV-2 serum antibodies for prompt identification of patients infected with COVID-19.
Methods: A multifaceted QI programme including a bundle of infection prevention control (IPC) measures was implemented across 5 ICHD units following the first wave of the pandemic in June 2020. Primary outcomes evaluated before and after QI implementation were incidence of outbreaks and severe COVID-19 illness defined as COVID-19-related death or hospitalization. Secondary outcomes included the proportion of patients identified in the pre-symptomatic/asymptomatic phase on surveillance rRT-PCR screening and the incidence and longevity of SARS-CoV-2 antibody response.
Results: Following the implementation of the QI project, there were no further outbreaks. Pre- and post-implementation comparison showed a significant reduction in COVID-19-related mortality and hospitalization (26 vs. 13 events, respectively, p < 0.001). Surveillance rRT-PCR screening identified 39 asymptomatic or pre-symptomatic cases out of a total of 59 rRT-PCR-positive patients (39/59, 66%). SARS-CoV-2 antibody levels were detected in 72/74 (97%) rRT-PCR-positive patients. Amongst rRT-PCR-positive patients diagnosed before August 2020, 96% had detectable antibodies until January 2021 (days from the rRT-PCR test to last antibody testing, 245-280).
Conclusions: Systematic implementation of a bundle of IPC measures using QI methodology and surveillance rRT-PCR eliminated outbreaks in HD facilities. Most HD patients mount and sustain antibody response to COVID-19 for over 8 months.
Keywords: Antibodies; COVID-19; Haemodialysis; Infection prevention control measures; Quality improvement; SARS-CoV-2.
【저자키워드】 COVID-19, antibodies, SARS-CoV-2, Haemodialysis, Quality improvement, Infection prevention control measures, 【초록키워드】 SARS-CoV-2, Antibody testing, pandemic, Mortality, Hospitalization, antibody, Antibody Response, outcome, rRT-PCR, Outbreaks, SARS-CoV-2 antibody, Asymptomatic, Surveillance, outbreak, pre-symptomatic, implementation, Patient, Infection prevention, Haemodialysis, serum antibody, methodology, incidence, Quality, Quality improvement, Longevity, PCR test, utility, First wave, patients, Bundle, Secondary outcomes, Primary outcomes, measure, COVID-19 illness, COVID-19-related death, serum antibodies, rRT-PCR test, MOST, severe COVID-19 illness, secondary, defined, proportion, detectable, diagnosed, evaluated, events, receiving, reduction in, eliminated, infected with COVID-19, 【제목키워드】 SARS-CoV-2, improvement, Testing, Quality, Quality improvement, nose, routine, role, Throat,