Nephrologists Transforming Dialysis Safety

NTDS Project Mission Statement

To enhance the quality of life for people with kidney failure by engaging nephrologists as team leaders in transformational change that continuously improves the safety of life sustaining dialysis.

Coronavirus Disease 2019 (COVID-19)

This page was last updated on April 9, 2020

Centers for Medicare & Medicaid Services (CMS) COVID-19 Resources:

• CMS Coronavirus Waivers & Flexibilities (Page Last Modified: 04/01/2020) New Resource
• Critical clarification from CMS: PD catheter and vascular access placement is essential. (Posted March 26, 2020)
• COVID-19 Medicare Provider Enrollment Relief FAQs (Posted March 23, 2020)
• CMS QMVIG Updates: CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 (Posted March 23, 2020)
• ESRD Provider Telehealth and Telemedicine Tool Kit (Posted March 20, 2020)
• The Telehealth Toolkit for General Practitioners is available from CMS. (Posted March 16, 2020)
• A fact sheet to aid Medicare providers with information relating to the pricing of both the CDC and non-CDC tests. (Posted March 12, 2020)
• Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in dialysis facilities. (Posted March 10, 2020)

The CDC Coronavirus Disease 2019 (COVID-19) Resources and Recommendations

• General Information:
  • What You Should Know, Situation Updates, and Latest News and Communications (Latest Update: April 7, 2020)

• Information for Healthcare Personnel:
  • Information for Healthcare Professionals (Page last reviewed: April 7, 2020) Updated Resource
  • Resources for Hospitals and Healthcare Professionals Preparing for Patients with Suspected or Confirmed COVID-19 (Page last reviewed: April 6, 2020)
  • Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance) (Page last reviewed: April 4, 2020)
  • Information for Clinicians on Therapeutic Options for COVID-19 Patients (Page last reviewed: March 21, 2020)
  • Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance) (Page last reviewed: March 16, 2020)

• Patient Safety:
  • Coronavirus Disease 2019: Keeping Patients on Dialysis Safe: This handout is for patients on dialysis to learn more about what COVID-19 means for their daily activities and their dialysis treatments. (Published: March 30, 2020)
  • How Our Facility is Keeping Patients Safe from COVID-19: This informational handout is for dialysis facilities to share with patients and caregivers to explain how they are preparing for the possible arrival of patients with COVID-19. (Published: March 26, 2020)
  • Screening and Triage at Intake CDC recommendations for identifying, separating, and putting facemasks on those patients who are ill. (Latest Update: March 25, 2020)

• Personal Protective Equipment:
  • The personal protective equipment (PPE) burn rate calculator is a spreadsheet-based model that provides information for healthcare facilities to plan and optimize the use of PPE for response to coronavirus disease 2019 (COVID-19). (Page last reviewed: April 7, 2020) Updated Resource
  • Strategies for Optimizing the Supply of PPE (Page last reviewed: April 3, 2020)

• Recommendations:
  • Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings (Page last reviewed: April 1, 2020)
  • Interim Additional Guidance for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities (Page last reviewed: March 30, 2020)
  • COVID-19 Outpatient Dialysis Facility Preparedness Assessment Tool (Latest Update: March 26, 2020)

ASN Resources and Recommendations

• Recommendations:
  • Recommendations on the Care of Hospitalized Patients with COVID-19 and Kidney Failure Requiring Renal Replacement Therapy. Physician leaders affiliated with the AKI!Now initiative have developed, in collaboration with the Centers for Disease Control and Prevention (CDC), general recommendations regarding in-hospital renal replacement therapy (RRT) for patients with COVID-19, and Acute Kidney Injury (AKI) or end-stage kidney disease (ESKD). (Added: March 21, 2020)
  • Information for Screening and Management of COVID-19 in the Outpatient Dialysis Facility. These ASN developed FAQs were drafted for dialysis facilities based on current CDC guidance and will be updated as new information becomes available. (Updated: March 13, 2020)

• Webinars:
  • Hospital Care and Treatment Options for COVID-19 Positive Patients with ESKD and AKI (Recorded April 2, 2020)
    This 60-minute recording addresses key areas of concern in the management of COVID-19 positive patients receiving renal replacement therapy in the hospital setting.
  • CDC Recommendations and Policy Updates for Current Challenges in the Dialysis Setting (Recorded March 26, 2020)
    Key Points included: CDC Recommendations: Environmental Cleaning and Disinfection, Criteria for Healthcare Personnel Return to Work, Discontinuation of Precautions and Home Isolation, PPE supply strategies; transportation recommendations; and telemedicine and quality reporting program waivers.
  • COVID-19 Informational Webinar for Providers of Dialysis Services (Recorded March 11, 2020)
    ASN conducted an informational webinar focusing on new COVID-19 guidance for dialysis facilities from CDC and a presentation on managing patients with COVID-19 who require dialysis.

• Podcasts:
  • COVID-19 Update: On the Front Lines in New York City ASN Executive Vice President Tod Ibrahim talks to ASN Councilor Dr. Barbara Murphy, who gives a gripping, detailed picture of how the Mount Sinai Health System in New York is dealing with the COVID-19 crisis. (20 min. April 8, 2020) New Resource
  • COVID-19 Update: Telehealth ASN Executive Vice President Tod Ibrahim interviews David White, ASN's Regulatory and Quality Officer, about policy updates in the field of telehealth during the COVID-19 pandemic. (20 min. April 4, 2020) New Resource

• Other:
  • COVID-19 Awareness Poster: To assist with the sharing of information within the dialysis facility, ASN has created a COVID-19 awareness poster for facility use. The COVID-19 Awareness Poster is also available in Spanish.
  • COVID-19 PREPRINT ARTICLES: Due to the high volume of information sought regarding COVID-19, a number of scholarly articles have been released as preprint resources. Articles that are labeled as preprints have not yet been reviewed or revised by other experts; they should not be relied on for clinical guidance. ASN has not reviewed, and does not endorse, any of these resources.

Publications

• Kidney360 has published Management of hemodialysis patients with suspected or confirmed COVID-19 infection: perspective of two nephrologists in the United States. (Added: March 27, 2020) New Resource
• The Clinical Journal of the American Society of Nephrology (CJASN) has posted a collection of resources on the COVID-19 pandemic (CJASN), including an article from NW Kidney Centers who are at the frontline of the pandemic. New Resources
• Mitigating Risk of COVID-19 in Dialysis Facilities. This concise publication brings the evidence-based guidance of the Centers for Disease Control and Prevention (CDC) and the practical judgment of dialysis clinicians, brought together by the American Society of Nephrology (ASN), to inform best practice for in-center hemodialysis. (Added: March 25, 2020)
• Kidney International has published The Novel Coronavirus 2019 epidemic and kidneys which examines kidney involvement in COVID-19 infections. (Added March 24, 2020)
• Nephron reports on recent findings on the effects of SARS-CoV-2 infection on kidney diseases, including acute kidney injury, and examine the potential effects of ARBs on the outcomes of patients with COVID-19: Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade (Published online: March 23, 2020).
• The New England Journal of Medicine has posted a collection of freely avaialable articles and other resources on the Coronavirus outbreak (NEJM), including clinical reports, management guidelines, and commentary.

Healthcare Partner Links

• Government Entities
  • The World Health Organization (WHO) is maintaining a page which posts situation reports, travel advice, and technical guidance, among other information.
  • HHS' Office of the Assistant Secretary for Preparedness and Response (ASPR) recommends that facilities contact their local/state health department and local/state healthcare coalition if supplies are running low. Click here for ASPR's regional contact information.
  • HHS' Organ Procurement and Transplantation Network (OPTN) has posted Information for transplant programs and OPOs regarding 2019 Novel Coronavirus on its site.
  • The U.S. Department of Veterans Affairs (VA) presented information on "COVID-19 VA Dialysis Preparedness" on March 11, 2020.
  • The Federal Drug Administration (FDA) has developed a page which includes updates, fast facts, and FDA's role. The FDA has also posted a Coronavirus (COVID-19) Supply Chain Update (FDA).

• Professional Organizations
  • The National Academy of Medicine has posted Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2(Posted: March 5, 2020)
  • The Association for Professionals in Infection Control and Epidemiology (APIC) has developed a COVID-19 Fact Sheet (APIC) in response to recent events.

COVID-19 Library

• This video, produced by ECRI, provides recommendations on how to use N95 respirators safely when normal procedures are challenging due to shortages: Safe Respirator Usage When Supplies Are Short. New Resource
• "The Coronavirus Explained & What You Should Do" is a short video from Kurzgesagt – In a Nutshell, a Munich-based YouTube channel, that uses colorful animation to explain COVID-19, what actually happens when it infects a human, and what we should all do to prevent its spread. (Posted: March 19, 2020)
• A compilation of preprint articles related to COVID-19.
• Sciendo has set up a free web resource listing all its Coronavirus Open Access articles (Sciendo).
• The Wall Street Journal (WSJ) has posted a special report on "The Coronavirus Crisis". View the WSJ special report here.
• The Semantic Scholar has posted a COVID-19 Open Research Dataset (CORD-19). This free resource contains over 29,000 scholarly articles about COVID-19.

Hand washing is essential. View the NTDS Resource Library for more information.

NEW ONLINE LEARNING MODULE. In partnership with the Centers for Disease Control and Prevention (CDC), NTDS is pleased to present this online resource, which presents core infection prevention and patient safety concepts in a case-based format. To view the Module, click here.

NTDS is pleased to present the Annual Report for Year 3 of the NTDS Project! To view the Report, click here.

Download the "Days Since Infection" Poster here.

Standardization of Blood Culture Collection for Patients Receiving In-Center Hemodialysis

In collaboration with the Centers for Disease Control and Prevention (CDC), Standardization of Blood Culture Collection for Patients Receiving In-Center Hemodialysis was developed by an NTDS workgroup in response to requests from healthcare professionals engaged in outpatient hemodialysis care. The document seeks to provide an accessible summary of information from published guidelines, reports and studies. Sample protocols for obtaining blood cultures and communication tools are provided. Collectively the information is intended to provide a reference for dialysis facilities as they develop facility-specific procedures, policies and protocols.

View the Standardization of Blood Culture Collection for Patients Receiving In-Center Hemodialysis resource here.

Flu season has arrived.

CDC recommends annual influenza vaccination for everyone 6 months and older with any licensed, influenza vaccine that is appropriate for the recipient's age and health status, (IIV, RIV4, or LAIV4) with no preference expressed for any one vaccine over another.

The CDC website offers many influenza-related resources:

• Recommendations: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season
• #Fight Flu: CDC Digital Media Toolkit: 2019-20 Flu Season
• Communication resources: Includes print materials, factsheets, and videos and podcasts




View these and other influenza-related CDC resources here.





Promising Practice: CDC Video- Speak Up: Making Dialysis Safer for Patients

The Coalition and the American Association of Kidney Patients have released a new video for patients on dialysis and dialysis staff about the importance of speaking up to prevent infections and improve patient safety. Infections are serious and sometimes life-threatening, but together we can do something to stop them. The video follows the journey of two patients on dialysis who feel empowered to speak up and share concerns about their treatment, in order to prevent infections. The video also highlights ways dialysis staff can create an environment where patients feel safe speaking up. This video is open access. You are free to use it in any communication channels. Patients are encouraged to post the video on social media and share with family and friends. Clinics are encouraged to show the video during dialysis treatments, play it in waiting rooms, and post links within patient and staff educational materials.

Click here to view Speak Up: Making Dialysis Safer for Patients.