Hemodialysis with cohort isolation to prevent secondary transmission during a COVID-19 outbreak in Korea

Abstract

Significance Statement Health care?associated infections during previous serious coronavirus epidemics resulted from human-to-human transmission in hemodialysis (HD) facilities. The authors analyzed the effect of a strategy of HD with cohort isolation on the secondary transmission of coronavirus disease 2019 (COVID-19) in HD facilities in Korea, which involves administering an immediate screening test for COVID-19 to all close contacts (patients on HD and health care workers) and strict maintenance of cohort isolation. Epidemiologic investigation and immediate screening tests across 11 HD centers identified 302 close contacts. HD with cohort isolation was maintained for a median of 14 days, and the transmission rate was 0.66% inside HD units. Clinical practice guidelines for HD with cohort isolation during COVID-19 outbreaks may successfully prevent secondary transmission through HD units. Background Health care?associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation?separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)?on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. Methods Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. Results As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. Conclusions The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.