COVID-19 Home Dialysis FAQs
 

  • What are workplace considerations for home dialysis staff and patients?

    All patients should have a 30-day supply of antibacterial pump soap, hand sanitizer, and face masks at home. Masks are in short supply and may be reused. Please advise patients to store masks in a clean area after use. We recommend patients who use masks for daily therapy (e.g. peritoneal dialysis (PD) patients and home hemodialysis (HHD) patients with buttonholes or CVCs) should use a mask for 1 week if not soiled, torn, or wet. Store masks in a clean area. For these patients, provide 10 masks per month. Patients at home who do not require routine masks for their daily dialysis treatments (e.g. HHD patients who use site rotation method of cannulation) should be provided 3 masks for 30 days.

    Educate patients and care partners that masks are in short supply and not to be distributed to friends and family members.

    Reeducate patients to disinfect equipment and tables used for dialysis with approved Sani-Cloth 1:10 Bleach wipes every dialysis treatment.

    If a patient or their family member develops a fever, cough, or other symptoms, instruct patients to contact the home nurse by phone for further instructions. DO NOT have patients come to the clinic.

    For required in-person clinic visits, all individuals will be asked about fever, cough, and foreign travel. All persons entering the clinic will be required to wear a mask upon entry, answer health screen questions, and undergo a temperature check.

  • What considerations should be taken for routine home dialysis training?

    Home dialysis training should preferably be done in the clinic. For home dialysis training, all individuals will be asked about fever, cough, and foreign travel, and will have a temperature check. All training participants will wear a mask and perform hand hygiene upon entry to the clinic and throughout the training session. Training staff will wear appropriated PPE as outlined in the updated COVID-19 policy.

    Care partners may be allowed to participate in training only if they are actively involved in the training. They will need to be screened and assessed similar to a home dialysis patient.

  • How should clinic visits for home dialysis be conducted?

    At this time, minimize in-person clinic visits. We recommend drawing monthly labs and holding the physician visits at the same time. Social workers and dietitians can attend clinic visits but must wear appropriate PPE. Laboratory results can be reviewed by phone, therefore decreasing the number of visits a patient and/or care partner must make to the clinic.

    Refer to the telehealth section of this document for more information on potential telehealth alternatives.

    We prefer that family members not attend clinic visits unless medically necessary. Ask family members to sit in the car or elsewhere, but not in the waiting room or lobby. However, if the care partner is essential to the treatment of the patient at home, they can attend the visit but will be required to comply with all screening, masking, and hand hygiene instructions during the visit.

  • Should home visits be conducted for home dialysis patients?

    Home visits in personalized care will be on hold until further notice. Phone calls should be conducted in lieu of home visits.

    If a patient requires a home visit, the patient and family members present will be required to wear a mask as well as anyone entering the home. All participants will be required to perform good hand hygiene. It is recommended that other interdisciplinary team (IDT) members participate remotely if possible.

    Pre-home assessments should be done without a home visit and by asking relevant questions to understand the home environment. We are in the process of creating a pre-home visit questionnaire that can be used for the pre-home assessment.

    Any FKC employee entering a patient home to provide service to equipment or for any other reason should wear a mask before entering. All visitors should perform hand hygiene upon entering and before leaving the home. Patients and family members if attending should also wear a mask during the visit and perform hand hygiene.

    Persons delivering dialysis equipment or supplies should also wear a mask before entering. Visitors should perform hand hygiene upon entering and before leaving the patient’s home. The patient should also wear a mask during the delivery and perform hand hygiene.

    Equipment swaps will continue to be provided as needed. Biomedical support will continue to be provided but consider rescheduling routine machine maintenance at this time.

  • What is our policy on vendor visits?

    All visitors to the home clinic will be restricted. This includes vendors, employee and patient friends or family members, pharmacy representatives, and vendor educators until further notice. Urgent vendor education may continue if approved. To obtain approval for vendor training contact Clinical Services at the Clinical Services Resource Line (877-567-6397 or clinicalservices@fmc-na.com).

  • What are the protocols for taking patient and staff temperatures?

    Our Fresenius Kidney Care clinics, both staff and patients must receive temperature checks and symptom screening every day (staff) and with every dialysis treatment (patients). We have multiple thermometers available for facility staff use; however, Tempa-Dot disposable thermometers are preferred as they are easily disposed of and have little to no risk of patient or staff cross-contamination.

    We require staff to be dressed in full PPE (including gown, gloves, surgical face mask, and full-face shield) when performing the required temperature and other screenings. To further reduce exposure, staff can also ask patients who are able to use the disposable Tempa-Dot to place the strip in their mouth, take their temperature, and report the result to clinic staff (under supervision). For patients who are unable to self-check temperature, staff should assist the patient in inserting the Tempa-Dot under their tongue and checking temperature. In these instances, the staff member should change their gloves after taking the patient’s temperature.

    Fresenius Kidney Care staff who are working in isolation clinics or shifts should actively monitor their temperature twice daily and monitor themselves for respiratory symptoms (cough, shortness of breath, sputum production, chest pain) when they are not in the dialysis clinic. They should immediately notify their manager and health care provider if they develop any fever (measured temperature ≥100.4 degrees Fahrenheit or subjective fever) or respiratory symptoms. Temperatures and symptom checks taken outside of work should be recorded and provided to the Clinical Manager, Charge Nurse, Facility Administrator, Home Therapy Program Manager, or Area Team Lead at the start of shift at dialysis clinic. Staff members who develop fever or respiratory symptoms should not report to work but should instead report their fever and respiratory signs or symptoms to their supervisor.

  • What are the protocols for mask use?

    Patients:
    Regardless of risk classification, all patients should be provided with a surgical mask upon entry to the any clinic. Patients are required to wear surgical face masks upon entry to the dialysis clinic and throughout the duration of dialysis treatment and discharge from the clinic post-treatment.

    Isolation Clinic Staff:
    All staff, including physicians and physician extenders, must wear full PPE including gowns, gloves, face shield, and N95 respirator masks facemasks and/or surgical masks when the availability of respirators cannot meet the demand.

    Non-Isolation Clinic Staff:
    All staff, including physicians and physician extenders, must wear full PPE including gowns, gloves, face shield, and surgical masks.

  • What are N95 Respirator Face Masks and how should they be fit?

    N95 respirators are the PPE used to control exposures to airborne transmitted infection, though their effectiveness is highly dependent upon proper fit and use. N95 respirators are designed to prevent the wearer from inhaling small airborne particles and must fit to the wearer’s face. Surgical masks, on the other hand, are intended to prevent microorganism transmission from the wearer to the patient by infections droplets. Medical masks also prevent hand-to-face contact and facial contact with respiratory droplets and sprays. COVID-19-virus is transmitted via respiratory droplet (i.e. cough, sneeze), and both surgical masks and N95 respirator masks will protect the wearer from droplet inhalation if a COVID-19 positive person coughs or sneezes on another person. The N95 respirator mask is provided as an extra precaution but due to supply shortages may not always be available. N95 respirator masks require the user either perform a fit test or seal test in the application of the mask prior to each use. If the user is unable to get a good seal with application, then a surgical face mask is the preferred mask for a staff member to use in caring for patients in either isolation clinics/shifts, or in non-isolation facilities. Surgical face masks can be used as a replacement to an N95 respiratory mask in isolation and non-isolation clinic settings. Some procedures performed on patients with known or suspected COVID-19 could generate infectious aerosols. Procedures that are likely to induce coughing (i.e. nasopharyngeal specimen collection) should be performed in full PPE including gown, gloves, full face shield, and N95 respirator mask. The N95 respirator provides a higher level of protection than the surgical facemask when performing or present for an aerosol-generating procedure like nasopharyngeal testing.

  • Due to the mandatory mask policy, are patients allowed to eat during treatment?

    Everyone in our clinic – patients, staff, and others – must wear a face mask in both the lobby and treatment area. COVID-19 spreads by particles when an infected person coughs or sneezes. These viruses can be picked up on our hands, and enter through our mouth, nose, or eyes.

    A patient may briefly adjust their mask to place medications, including protein supplements, in their mouth, as well as have their temperature taken or low blood sugar treated. After doing these things, the patient must readjust the mask to cover their nose and mouth. Should be eaten prior to a patient arriving to our center or when they arrive home. We also suggest the patient carry a snack that they can eat after you leave the clinic.
    Patients who refuse to follow this new policy will not be able to receive treatment.

  • How should we treat tracheotomy patients?

    We advise that you cap the tracheotomy if possible, and suctioning should not take place in the clinic if possible. Please always use a mask to properly cover the tracheotomy.

  • Are staff allowed to gather in the breakroom or common areas?

    We advise that you cap the tracheotomy if possible, and suctioning should not take place in the clinic if possible. Please always use a mask to properly cover the tracheotomy.

  • How should COVID-19 positive or quarantined patients or patient family members be addressed in home dialysis?

    Patients and/or family members who have tested positive for COVID-19 or in quarantine should not attend in-person clinic visits at this time. Home visits in personalized care will be on hold until further notice. Phone calls should be conducted in lieu of home visits. Patients who test positive should notify their home therapy nurse immediately for further instruction.

    If necessary, clinic visits should be conducted in the patient’s home. For all essential home visits or in-home clinic visits, the nurse will bring appropriate PPE for the physician (if applicable) and the nurse for the visit. Follow the policy for PPE and infection control precautions as you would in the clinic setting.

    For patients who test positive during home training, contact Clinical Services Clinical Services at the Clinical Services Resource Line (877-567-6397 or clinicalservices@fmc-na.com).

    Any additional questions can be directed to Clinical Services and/or the Medical Staff Office.