Severe infectious diseases like Coronaviruses (CoV), Ebola, etc are said to be public health emergencies and the outbreak of these diseases ends in tragically disruptive events.
The prevalence of viral outbreaks among patients treated in hemodialysis facilities is five times higher than among the general population and predisposes the patients to serious consequences. One of the major reasons for the viral outbreak is inappropriate risk management. And the outbreaks are exacerbated when seen along with natural disasters, power outages, and civil disturbance. In the middle of the widespread of infectious diseases, Health Care Workers (HCW’s) experience a huge amount of contact with the patients and thus subject to substantial risks, these risks increase with shortage of HCW’s at the period of outbreak and become worse with lack of supply of personal protective equipment (PPE) and basic reserves such as power and water.
HCW’s lack of training, types of equipment, people power, capacity to respond to viral outbreaks, lack of knowledge about what works and what does not in determining appropriate clinical outcomes leave HCW’s vulnerable to illness through the treatment of patients.
All the patients and medical staff exposed to a viral outbreak should follow the guidelines by National Disaster Management. As per National Disaster Management, all patients and medical staff exposed to a viral outbreak should be kept under isolation in the hospital or their home. Medical isolation and subnormal quality of care during the viral outbreak cause extreme stress in hemodialysis patients and this stress affects the clinical parameters such as hemoglobin, hematocrit, and adequacy of dialysis treatment (Kt/V).
Isolation of hemodialysis patients during the viral outbreak is necessary to maintain dialysis and prevent additional infections. Dialysis units must be prepared to avoid the spread of infectious diseases while dialysis continues. Implementation of aggressive infection control practices and isolation of confirmed and suspected cases reduces the spread of infection during the outbreak. Single room isolation with separate dedicated machines for suspected/infectious patients and hemodialysis with one-bed width distance from the neighboring patient in patients classified as low risk for the outbreak.
The Centers for Disease Control and Prevention (CDC) guide safe use of acute hemodialysis including specific methodologies, equipment, personal protective equipment (PPE), and disposal of waste products. 
The Centers for Disease Control and Prevention (CDC) strongly recommends the practice of hand hygiene, appropriate central venous catheter care, use of antiseptic agents, proper maintenance of checklists and staff and patient education.
The hemodialysis unit maybe a easy source of outbreak due to inadequately cleaned and disinfected dialysis stations, use of priming buckets, inadequate surface cleaning of hemodialysis machines after each treatment, lining of effluent drain pipes, use of mitivial heparin and saline, HCW’s made numerous passages from one patient to another or a hemodialysis machine or a keyboard without changing gloves or without handwashing especially during busy periods and emergencies, reuse of dialysers, internal contamination of hemodialysis machines, lack of standard precautions like hand hygiene, proper use of gloves and safety injection practices have been recognized as leading cause of viral outbreak in hemodialysis settings.
Above all of these, kidney failure itself interferes with the body’s natural defense system making it easier to get the infection through dialysis treatment.
In a Dialysis unit, a viral outbreak can happen whenever standard precautions are not strictly applied. The outbreaks can be dealt with improved infection control education and training for all hemodialysis facility staff, periodical auditing on standard precautions, use of single-dose vials wherever possible, surveillance for infections and risk assessment and management are the cornerstone to contain and prevent outbreaks in hemodialysis setting.
Although dialysis therapy during the outbreak does entail inherent risk to HCW’s, precise training and strict adherence to the protocol can allow HCW’s to provide effective care to the patient while minimizing their own risk. Dialysis therapy can be provided safely to patients as long as attention and care are given to the patient, Health care workers, and community safety.
LazyKidney 