CDC has released a new HAN Health Alert Advisory on Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate to Prevent and Treat COVID-19. The Summary includes “Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound hydroxychloroquine, should be used only under the supervision of a healthcare provider as prescribed medications.” Find the CDC HAN at https://emergency.cdc.gov/han/2020/han00431.asp?deliveryName=USCDC_511-DM24285.
ASN will present a March 26, 2020 webinar on COVID-19: CDC Recommendations and Policy Updates for Current Challenges in the Dialysis Setting. Topics will include personal protective equipment, discontinuation of isolation, variation in interpretation by states and potential lack of uniform application of CDC recommendations, patient transportation challenges, telemedicine waivers, and QIP waivers. Find more information and register at https://register.gotowebinar.com/register/6032221362410158859.
You can find a recording of ASN’s March 11, 2020 webinar on COVID-19 Information for Providers of Dialysis Services at https://www.asn-online.org/ntds/resources/Webcast_2020_03_11_COVID-19.mp4.
Home Dialysis Central has added a very thorough post to their blog on How to Support Home Dialysis Patients During a Pandemic. Find it at https://www.homedialysis.org/news-and-research/blog/351-how-to-support-home-dialysis-patients-during-a-pandemic.
CDC has released a number of new Guidance protocols today on:
- Return to Work Criteria for Health Care Personnel with Confirmed or Suspected COVID-19, at https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html, including sections on Return to Work Practices and Work Restrictions, and Crisis Strategies to Mitigate Staffing Shortages.
- Strategies to Optimize Personal Protective Equipment Supply, at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html, including sections on eye protection, isolation gowns, facemasks, and N95 respirators.
- Disposition of Non-Hospitalized Patients with COVID-19, at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html, which provides various protocols for allowing patients to discontinue home isolation.
CDC has issued a New HAN Health Alert titled Information and Guidance about Global Travel on Cruise Ships, Including River Cruises, Due to COVID-19, dated March 15, 2020. Among other things it recommends that clinicians “ask all patients about their planned or recent cruise ship travel, including river cruises.” See https://emergency.cdc.gov/han/2020/han00430.asp.
On March 12 CMS published a FAQ sheet about Essential Health Benefits Coverage to ensure individuals, issuers, and states have clear information on coverage benefits for COVID-19. Find it at https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf.
CMS Emergency Preparedness & Response Operations has a Current Emergencies web page that lists emergency-related documents, and which could be an ongoing reference for what’s new. It includes links to the press release and Fact Sheet about the National Emergency declared on March 13, but neither document includes information specific to dialysis facilities or transplant centers. Find the web page at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.
If you bookmarked our web page on Network Guidance on COVID-19 Stress for Staff, or forwarded the blog post about it, on March 13 or 14, please make sure you’re linking to https://www.esrdnetwork18.org/wp-content/uploads/20200313-Coping-with-ID-Outbreaks.pdf and advise the people to whom you forwarded the post. The following day we corrected the link in the blog post, but the original included a typo.
Both ASN and NTDS have published guidance for dialysis facilities on dealing with COVID-19:
- ASN – Information for Screening and Management of COVID-19 in the Outpatient Dialysis Facility, https://www.asn-online.org/g/blast/files/DIALYSIS%20COVID%202019%20Update%202.28.20%20FINAL.pdf. A few excerpts:
- “Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough). Identify patients before or immediately upon arrival to the dialysis facility (e.g., during or before patient triage or registration at the time of patient check-in). Ask all patients about fever or symptoms of lower respiratory tract infection, including cough or trouble breathing. Ask all patients about travel to an affected geographic area in the last 14 days OR contact with a patient with known COVID-19 illness.”
- “At present, samples should be taken in an airborne isolation room or examination room with a door closed by a healthcare provider wearing appropriate PPE (gown, gloves, eye protection,and a fit-tested N-95 mask or higher-level respirator). Dialysis patients who require testing will need to be transferred to a facility with these capabilities. Notify and discuss with the health department prior to transfer to determine appropriate disposition. In addition, notify the receiving facility before transferring a patient who meets PUI criteria.”
- “Shared decision making between health departments and clinicians should occur when testing is considered. The ‘Person Under Investigation’ (PUI) definition can be used to help inform testing decisions but reliance on the PUI definition should never impede or override clinical judgment. The PUI definition can change over time as more is learned so check here for the current definition: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.”
- “Most dialysis facilities do not have airborne isolation rooms (AIIR). Currently PUIs or individuals with confirmed COVID-19 should not receive dialysis in an outpatient dialysis facility due to inability to perform dialysis in an AIIR. Therefore, if unable to perform home dialysis, these individuals will need to undergo dialysis in an acute care hospital in an AIIR. The decision to transfer care back to the dialysis facility should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.”
- NTDS – Coronavirus, https://www.asn-online.org/ntds/. This is a comprehensive list of resources, including all relevant CDC links. One example resource is an APIC FAQ at https://apic.org/wp-content/uploads/2020/02/02420_Coronavirus_HiresNoBleed.pdf. Another is a suggested poster for your facility, at https://www.asn-online.org/g/blast/files/Coronavirus%20poster%2002.28.2020%20R.pdf and reproduced below:
The National Forum of ESRD Networks Medical Advisory Council Vaccination Toolkit (Revised 2020) was updated in January 2020. Find it at https://esrdnetworks.org/resources/toolkits/mac-toolkits-1/vaccination-toolkit/vaccination-toolkit-revised-2020/view.
The Centers for Disease Control and Prevention (CDC) and the ASN Nephrologists Transforming Dialysis Safety (NTDS) group have partnered to develop a new online learning module, Managing Infection in an Outpatient Dialysis Facility. Find it at https://www.asn-online.org/ntds/olm.aspx.
A new MEI online continuing-education course on Include Dialysis Patients in your Facility Culture of Safety focuses on effective systems and teamwork – including patients – to accomplish the mutual goal of safe, high-quality patient care. When something goes wrong, the focus is on what, rather than who, is the problem, with the intent to bring process failures and system issues to light and solve them in a non-biased, non-threatening way. Find the course at https://course.wcea.education/app/mei/elearning/nurse/medical-education-institute/194758/include-dialysis-patients-in-your-facility-culture-of-safety.
CMS reviews where we are with the “ordinary” flu, and what we need to do about it, at https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-13#_Toc32395783.
And last but certainly not least, you can find CDC’s nexus page on the Coronavirus that began in Wuhan, China, which the WHO has named “Covid-19,” at https://www.cdc.gov/coronavirus/2019-ncov/index.html. The WHO’s central page on Covid-19 is located at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.