Questions About PD
Thank you for this very timely question. During the very early months of the COVID-19 pandemic, with many jurisdictions under “Lockdown” or “Shelter-at-Home” orders, the ISPD Guideline Committee March 28 2020 came out with guidelines and recommended that “home visits by healthcare professionals should be minimized or stopped” (1). Also, the British Renal Society, April, 2020, recommended “Routine home visits should be suspended and replaced by regular telephone contact” (2).
We are now several months later into the pandemic, some communities opening up restrictions, and you wonder if PD units are still limiting/restricting home visits. To answer your question, the members of the ISPD Nursing Liaison Committee during the week of August 16th 2020 undertook a very simple survey of member practices in different countries. Here is what we found:
Brazil — Home PD units: Practice of home visits varies by area of the country. In the south, where the number of COVID-19 cases is increasing, they are still following the initial precautions — home visits not allowed. In the north, northeast, southeast and midwest practices are getting back to more normal, but nurses wear masks, face shields, aprons and practice good hand hygiene during home visits.
Canada — Two home PD units in Toronto: In the one unit, home visits stopped initially, they are now not limiting the visits. In the other unit, home visits were initially much reduced, now they have slowly started to increase visits. For both units, just prior to the visit, the home PD nurse phones the patient/family and screens for COVID-19 symptoms, recent travel outside of Canada, close contact with people who have COVID-19. Masks and face shields are worn by the nurses during the visit, good hand hygiene is practiced. Masks worn for patients and family members.
England — Home PD units in London and Manchester: While home visits during the height of the pandemic there in March/April were initially limited and only conducted with full Personal Protective Equipment (PPE), now it is “back to normal as much as possible”. However, screening with COVID-19 questions prior to the visit, masks, gloves, good hand hygiene practiced by nurses during these home visits.
New Zealand — Home PD units: Country was until recently in Level 1 when home visits were normal – but a COVID-19 screening tool was still used prior to the visit. They are now in Level 2. COVID-19 screening tool used before all home visits, but now masks worn by nurses, good hand hygiene.
U.S.A. — Two home PD locations: While initially reducing home visits, now not restricting visits, but with COVID-19 screening questions prior to the visit, limiting family members present/those present to wear masks, full PPE for nurse when entering the home. Bringing garbage bag for disposal of PPE on leaving the home, sanitizer wipes for cleaning shoes and dispose in garbage bag, plus hand sanitizer for hand hygiene. Visits with same precautions in place also made to deliver supplies, when vendor not able. Other units may be only conducting “virtual” home visits.
The authors of this very recently published article on “Home dialysis in the COVID-19 era” recommend that local rates of community prevalence of COVID-19 should guide this effort to “reopen” home dialysis programs (3). Overall, we would also say from the results of this survey that PD nurses in different countries continue to adapt their home visit practices according to the changing level of community spread of COVID-19. Of note, most units now have pre-visit COVID-19 screening in place, but level of PPE worn by the nurse varies according to the level of community spread. Masks are worn by the patient and family during the visit.
1. International Society for Peritoneal Dialysis (ISPD). Strategies regarding COVID-19 in PD patients Adapted from Peking University First Hospital. March 28, 2020. Available at: https://ispd.org/wp-content/uploads/ISPD-PD-management-in-COVID-19_ENG.pdf
2. British Renal Society. COVID-19: Checklist and Guidance for management of Peritoneal Dialysis Programmes. April 2020. Available at: https://renal.org/wp-content/uploads/2020/04/COVID19-and-PD-30032020-Checklist-and-Guidance.pdf
3. Yerram P, Misra M. Home Dialysis in the Coronavirus Disease 2019 Era (In Press). Advances in Chronic Kidney Disease. Available at: https://www.sciencedirect.com/science/article/pii/S1548559520301117