I work in outpatient hemodialysis as well as acute dialysis which includes hemodialysis as well as other modalities. When COVID-19 arrived and multiple policies were implemented, the outpatient setting did a very good job designating clinics where patients would receive their treatments who were classified as Covid positive or other designations of PUI. As time passed however, I started to notice (exceptions) in the outpatient setting regarding prescreening of patients. There are multiple examples but one is a patient with a fever of unknown origin >101 degrees and shortness of breath. I would like to clarify that many hemodialysis patients have shortness of breath from time to time when they become fluid overloaded or are having pulmonary edema. But these exceptions were driven largely by nephrologist orders although they were in conflict with current policies. I became frustrated with the potential for disease transmission potential for other patients as well as staff members given the 2 to 14 day incubation period. The PPE that staff wear in the outpatient setting is about as good as anyplace I’ve ever seen other than the hospital setting where positive patients are basically treated like droplet, contact or aerosol at all times. The clinic setting is basically a droplet/contact setting for the entirety of time patient’s receive treatment. After several weeks passed, i started to notice that I was feeling more comfortable in a Covid-19 positive room in the ICU where a patient was prone and intubated than I was in a designated non COVID-19 clinic in outpatient. The talented doctors and nurses that surround me are amazing. My concern regarding this discussion is that I’m feeling that I’m at a crossroads where I may leave the clinic setting, which I enjoy but I feel more safe in a setting that is dangerous but 100 percent acknowledges appropriate infection control.
Just a late night ramble:)