key: cord-266261-6h7c26xg
authors: Bharati, Joyita; Ramachandran, Raja; Kumar, Vivek; Kohli, Harbir Singh
title: COVID‐19 pandemic in limited‐resource countries: Strategies for challenges in a dialysis unit
date: 2020-07-12
journal: Nephrology (Carlton)
DOI: 10.1111/nep.13748
sha: 
doc_id: 266261
cord_uid: 6h7c26xg

nan

South and South-East Asian countries are densely populated regions with inadequate health-care infrastructure. The rapid surge of novel coronavirus disease 2019 (COVID-19) pandemic has brought unique challenges. We describe our solutions for these challenges in a limited-resource setting.

Our unit is a tertiary referral centre with 30 haemodialysis stations. In addition to stable patients, around 10 cases of advanced renal failure with symptoms camouflaging severe acute respiratory illness are admitted daily. In the absence of universal testing, apprehensions related to inadvertent exposure to COVID-19 positive patient was increasing among health-care workers (HCW) and patients, which was crucial to be addressed to maintain functionality of the unit. A risk stratification algorithm after inadvertent exposure to COVID-19 positive patient was adapted from the U.S. Centers for Disease Control and Prevention (CDC) to educate HCW. 1,2 A flow-chart simplified the interpretation of CDC tables for risk stratification which were found intricate by HCW. HCW were asked to lead, screen patients and discuss to ensure confidence building and transparency. Inculcation of "leadership quality" to frontline dialysis HCW constantly motivated them to function without any fear. Universal masking, hand hygiene and separation of adjacent dialysis stations by 2 m was done. 1 Of the two operating rooms, one was converted to COVID isolation room.

Creation of a proper doffing area was consequential to sacrificing one of the two waiting areas. They were in proximity to each other. 

Protocol for hemodialysis unit during COVID-19 pandemic. PGIMER COVID-19 portal

guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease

The authors declare no conflicts of interest. 
