Analysis of the operation of dialysis centres during the COVID-19 pandemic

Abstract

Monitoring and assessment of the implementation of the National Program of Prevention, Treatment, Advancement and Control of Renal Insufficiency and Dialysis Development in the Republic of Serbia by 2020 has been implemented by the Institute of Public Health of Serbia "Dr Milan Jovanović Batut". As the mode of dialysis centres operation changed after the COVID-19 epidemic was proclaimed, whereby some centres started operating in the Covid-regime, while Covid-negative patients from these centres were rerouted to the closest dialysis centres with available capacities, the need for monitoring and assessing the conditions for the implementation of the chronic dialysis program was further emphasized. The purpose of this paper is to provide a retrospective analysis of the conditions for the implementation of a chronic dialysis program in healthcare institutions within, and outside of the Network Plan during the COVID-19 outbreak in the period from the beginning of the epidemic to 1 October 2021. For the purposes of this study, a special questionnaire was designed, which was filled in by dialysis centres. The questionnaire consisted of three parts pertaining to: a) implementation of infection prevention measures at the dialysis centre, b) availability of personal protection equipment and disinfectants at the dialysis centres during the COVID-19 pandemic and c) conditions for the provision of dialysis services to patients positive for, or suspected of, COVID-19 infection. In the observed period, as much as 39% of the dialysis centres were designated to receive patients from other healthcare institutions, which called for additional efforts in organising and pursuing transmission containment. Implementation of transmission prevention measures in the dialysis centres was maintained at a very high level (between 95.5 and 100%). Only 10-15% of dialysis centres reported occasional shortages of individual items from the personal protective equipment or disinfectant categories. Almost one in five dialysis centres received a higher number of patients during the outbreak than was the case in the pre-pandemic period. In that sense, it was difficult to maintain the necessary physical distance in an already limited space, and to organize work in shifts as human resources were restricted. In addition to the general documents pertaining to infectious disease transmission prevention and containment, a protocol needed to be elaborated to organize the operation of dialysis centres in an outbreak such as the one caused by the SARS-CoV-2 virus.