oa Effective approach to manage COVID-19 challenges in Hamad General Hospital dialysis facilities

Background: Hamad Medical Corporation (HMC) is providing dialysis treatment to approximately 1050 patients. COVID-19 started from China in December 2019^1,2, and the first case in Qatar was confirmed on 27^th February 2020. There were challenges to provide dialysis treatment for COVID-19 positive and negative patients during the pandemic due to severe staff shortage³, staff fear and psychological distress, workload, lack of dialysis slots, prolonged working hours and staff fatigue. Some staff were even deployed to COVID-19 facilities (modular dialysis services, hotel and quarantine facilities) to provide treatment. Methods:

1. 1) A COVID-19 management committee was established
2. 2) An on-call team was assigned to manage new cases and review dialysis slots availability.
3. 3) Staff performance and adherence to safety measures was monitored.
4. 4) A hierarchy model was implemented for COVID-19.

A) Elimination:

1.  – Confirmed COVID-19 patients were not to receive dialysis at Ambulatory Dialysis centres.
2.  – Unit meetings were only held online.

B) Substitution:

1.    – Dialysis services were to be provided in HMC dialysis facilities, COVID-19 hospitals, and isolation/quarantine facilities (home/hotels).
2. – Administrators with chronic disease worked from home.

C) Engineering:

1. – Reduce number of chairs in tearoom and waiting area
2. – Rearrange offices, working spaces, and conference room to keep everyone 2 meters apart.

D) Administrative:

1.   – Staff, patient and family education
2.   – Screening by using visual triaging scale
3.   – Deployment of staff
4.   – Managing staff mental health and psychosocial well-being

Results: 76 dialysis patients and 30 dialysis staff were infected. 900 hemodialysis sessions were provided inside quarantine and isolation facilities (home, hotel, Bu-Sidra, and other locations) and Hazm Mebaireek General Hospital (HMGH) Modular Dialysis Unit from March to October 2020 (Figure 1). The number of COVID-19 positive patients reduced from 39 in May 2020 to 12 in July 2020 (p = 0002) (Figure 2). Conclusion: Thanks to our approach, we were able to provide a high quality and safe dialysis service for in-centre dialysis and in COVID-19 facilities and quarantine centres (home/hotels).