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

A. Patients with end stage renal disease on maintenance hemodialysis cannot be subjected to a self-imposed quarantine because they have a routine thrice weekly hemodialysis treatment schedule. B. A patient with suspected or confirmed MERS-CoV infection in a hemodialysis facility should be transferred to a healthcare facility with a MERS clinic and hemodialysis capacity or placed on dialysis in an isolation room with a portable dialysis machine. Close contacts (other hemodialysis patients and health care workers) without fever or respiratory symptoms should be subjected to a single-room or self-imposed quarantine for 14 days from the last exposure (cohort isolation). C. If a patient in a hemodialysis facility becomes subjected to self-quarantine by close contact with a confirmed case, the facility should follow basic principles provided by the disease prevention authority. Individuals under self-quarantine should be monitored for the development of any suspicious symptoms and receive hemodialysis treatment separately. D. In the case of self-quarantine, transport between home and the hemodialysis facility should be provided by the disease prevention authority. E. Inter-hospital transfer is basically prohibited during a nation-wide epidemic, such as the MERS-CoV outbreak. If referral to another hospital is inevitable, the attending physician should decide to transfer after careful discussion between hospitals. F. Inter-hospital transfer should be performed only when it is reasonably safe to transport the patient to other facilities in that he/she is out of the incubation period and tests of MERS-CoV show negative results. The attending physician should decide to transfer after careful discussion between hospitals. G. Standard, contact, and droplet precautions should be appropriately educated and adhered to by all patients and health-care workers in hemodialysis facilities. If a patient develops a fever or respiratory symptoms, he/she should notify health-care workers in advance of visiting the hemodialysis facility.