Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

Park, Hayne Cho; Lee, Young-Ki; Lee, Sang-Ho; Yoo, Kyung Don; Jeon, Hee Jung; Ryu, Dong-Ryeol; Kim, Seong Nam; Sohn, Seung Hwan; Chun, Rho Won; Choi, Kyu Bok

To minimize the transmission of MERS-CoV within hemodialysis facilities, the following measures should be implemented. First, all health-care workers, hemodialysis patients and caregivers should perform standard, contact, and droplet precautions, including hand hygiene and wearing masks. Second, the screening desk or quarantine clinic should be operated to check body temperature and respiratory symptoms before patients enter the hemodialysis unit. If a patient on maintenance hemodialysis develops a fever or respiratory symptoms, he/she should notify the health-care workers as soon as possible. It is most important not to allow suspected or confirmed MERS-CoV infected patients into the hemodialysis unit. Third, to minimize contact between suspected or confirmed cases and other hemodialysis patients in the waiting room, it is highly recommended to operate the hemodialysis clinic by subscription and to educate patients to observe treatment hours. Next, to prevent nosocomial transmission in hemodialysis facilities, it is recommended that adequate space between beds be maintained. Lastly, inter-hospital transfer is basically prohibited during a nation-wide epidemic, such as a MERS-CoV outbreak. If a referral to another hospital is inevitable, a staff member from the relevant hemodialysis unit should discuss the referral issue with the head of the community health center beforehand. The attending physician should also discuss the referral issue with the referral hospital. The patient should be reasonably safe for transport to other facilities in that he/she is out of the incubation period and tests of MERS-CoV show negative results.