COVID-19 pandemic has lasted for almost 3 years. It influenced on public security, everyday activities and even our health especially the outbreak of 5th wave of COVID-19 pandemic. It has overwhelmed medical system in Hong Kong which resulting from the shortage of negative pressure system. In-hospital infection rates were very high.
There was tremendously increased in haemodialysis (HD) service demand by 52% in our HD unit of Pamela Youde Nethersole Eastern Hospital within 3 weeks’ time from the mid of February 2022. We had to cater not only our existing patients with confirmed COVID-19 infection, but also other patients referred from private or community dialysis centres. It was rapidly achieved our HD isolation capacities and overwhelmed staff’s workload in light of the already tight capacity in normal time.
With combating huge outbreak of COVID-19, non-urgent medical services have been suspended. However, hospitalised haemodialysis (HD) service which is a life sustaining treatment must be continued even in a critical situation where isolation facilities are tight and overloaded. It was a very challenging time for staff working in dialysis unit and dialysis patients and carers.
Therefore, appropriate preventive strategies had been rapidly employed to support an upsurge in service need and minimize risk of COVID-19 among patients. There were rescheduled patient’s HD sessions, installed exhaust fan in single rooms, modified non-isolation cubicles to higher standard protected area by adding portable HEPA filter, deployed staff to other isolation facility area for supporting HD service. However, it could not cope with huge service demand.
We had collaborated with Nethersole Clinical Simulation Stimulation Training Centre to pilot an innovative measure to release more isolation facilities for HD patients with COVID-19 infection by using of Fast–track Vented Enclosed System. It was applied in a non-isolation HD area of our HD unit for patients who were releasing confirmed COVID-19 infection with negative result of Rapid Antigen Test of SARS-CoV-2 from 29/3 to 4/5/2022. The system included reusable components including pipes, a pump with U-pa antimicrobial filter and anti-viral hood to simulate stimulate negative pressure ward. It could reduce aerosol transmitted infection by achieving 80 air changes per hour (ACH) which could support 4 individual plastic tents at the same time. The plastic tent sprayed with antiviral substance for prevention of virus attaching to plastic material and thus no need to cleanse in between patient’s use. It reduced our patient’s waiting time for HD treatments.
A survey with 6 Likert-type scale was distributed to all participants for feedback collection. There was positive feedback from 19 patients and 17 nursing staff. Patients expressed they felt safe and protected from others when placed inside the tents. No adverse effect on patients was noted. Nursing staff found it easy to use and felt protected when the system was applied to patients. However, some modifications of the system would be carried out for further clinical application such as fixing hoods connection firmly, adjustable height designed to suit hospital bed, noise reduction from a pump.
In conclusion, the use of Fast –track Vented Enclosed System in renal dialysis centre could help in protecting patient and staff safety by minimizing environmental contamination in the shortage of isolation facilities during the 5th wave of COVID-19.
Author: Ms. Ho Hau Sim, Nurse Consultant (Renal Care), HKEC MED