PPE and use of masks by dialysis patients

Last Updated – 06/04/2020

COVID-19: PPE and use of masks by dialysis patients

A statement on PPE usage for the care of dialysis patients has been made to clinical directors by NHSE&I national renal network leads to clinical directors. Please could all colleagues who are involved in the care of patients receiving dialysis read the below statement: 

Today the UKRR has published data that shows the high prevalence and mortality related to SARS CoV-2 in dialysis patients.

926 new cases of SARS CoV-2 have been identified this week in dialysis patients, with a mortality at 2 weeks of 15.2%. This is equates to a many-fold higher risk of confirmed infection than within the general population.

As you may be aware new PPE guidance have been issued.

This publication reflects that SARS CoV-2 is circulating in the community at high rates and that there are challenges in establishing whether patients and individuals meet the case definition for COVID-19 prior to a face-to-face assessment or care episode.

For those providing care for dialysis patients there are several key messages.

We have already issued guidance to state that dialysis patients should now be considered to fall into the highly vulnerable shielded status. The new PPE guidance states:

For delivery of care to any individual meeting criteria for shielding (vulnerable groups) in any setting, as a minimum, single use disposable plastic aprons, gloves and surgical mask must be worn for the protection of the patient.

Therefore all staff caring for dialysis patients should use PPE as stated.

We have specifically raised the need to consider the very specific situation of masks for dialysis patients with NHSE&I and continue to consider this. However we do feel that the guidance as issued supports the use of masks in this population.

In addition to acknowledging the high rate of SARS CoV-2 circulating in the community and the challenges of diagnosis before clinical assessment, the document states that for patients

In clinical areas, communal waiting areas and during transportation, it is recommended that possible or confirmed COVID-19 cases wear a fluid-resistant (Type IIR) surgical face mask (FRSM) if this can be tolerated. The aim of this is to minimise the dispersal of respiratory secretions, reduce both direct transmission risk and environmental contamination.

Dialysis patients are often travelling to dialysis in cohorts and then being treated in close proximity, and  can, according to Wuhan data, present in an atypical manner. We therefore feel that dialysis patients should, according to this guidance, be wearing masks when travelling to dialysis and in waiting areas before dialysis treatment and assessment. As masks are provided for patients for travel and waiting rooms, these logically should also be worn within the unit for treatment, if tolerated.