Ravi Thadhani1, Joanna Willetts2, Catherine Wang3, John Larkin2, Hanjie Zhang4, Lemuel Rivera Fuentes4, Len Usvyat2, Kathleen Belmonte5, Yuedong Wang3, Robert Kossmann6, Jeffrey Hymes2, Peter Kotanko4,7, Franklin Maddux8. 1. Partners HealthCare, Boston, MA, United States. 2. Fresenius Medical Care, Global Medical Office, Waltham, United States. 3. University of California-Santa Barbara, Santa Barbara, California, United States. 4. Renal Research Institute, New York, United States. 5. Fresenius Kidney Care, Waltham, United States. 6. Fresenius Medical Care North America, Medical Office, Waltham, United States. 7. Icahn School of Medicine at Mount Sinai, New York, United States. 8. Fresenius Medical Care AG & Co. KGaA, Global Medical Office, Bad Homburg, Germany.
Abstract
BACKGROUND: SARS-CoV-2 is primarily transmitted through aerosolized droplets; however, the virus can remain transiently viable on surfaces. OBJECTIVE: We examined transmission within hemodialysis facilities, with a specific focus on the possibility of indirect patient-to-patient transmission through shared dialysis chairs. DESIGN: We used real-world data from hemodialysis patients treated between February 1 st and June 8 th , 2020 to perform a case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) in the same dialysis shift and traced back 14 days to capture possible exposure from chairs sat in by SARS-CoV-2 patients. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. SETTING: 2,600 hemodialysis facilities in the United States. PATIENTS: Adult (age ≥18 years) hemodialysis patients. MEASUREMENTS: Conditional logistic regression models tested whether chair exposure after a positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. RESULTS: Among 170,234 hemodialysis patients, 4,782 (2.8%) tested positive for SARS-CoV-2 (mean age 64 years, 44% female). Most facilities (68.5%) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30% (95%CI 0.90%, 1.87%) of cases and 1.39% (95%CI 0.97%, 1.97%) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR=0.94; 95%CI 0.57 to 1.54; p=0.80). Results remained consistent in adjusted and sensitivity analyses. LIMITATION: Analysis used real-world data that could contain errors and only considered vertical transmission associated with shared use of dialysis chairs by symptomatic patients. CONCLUSIONS: The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low. PRIMARY FUNDING SOURCE: Fresenius Medical Care North America; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067).
BACKGROUND: SARS-CoV-2 is primarily transmitted through aerosolized droplets; however, the virus can remain transiently viable on surfaces. OBJECTIVE: We examined transmission within hemodialysis facilities, with a specific focus on the possibility of indirect patient-to-patient transmission through shared dialysis chairs. DESIGN: We used real-world data from hemodialysis patients treated between February 1 st and June 8 th , 2020 to perform a case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) in the same dialysis shift and traced back 14 days to capture possible exposure from chairs sat in by SARS-CoV-2 patients. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. SETTING: 2,600 hemodialysis facilities in the United States. PATIENTS: Adult (age ≥18 years) hemodialysis patients. MEASUREMENTS: Conditional logistic regression models tested whether chair exposure after a positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. RESULTS: Among 170,234 hemodialysis patients, 4,782 (2.8%) tested positive for SARS-CoV-2 (mean age 64 years, 44% female). Most facilities (68.5%) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30% (95%CI 0.90%, 1.87%) of cases and 1.39% (95%CI 0.97%, 1.97%) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR=0.94; 95%CI 0.57 to 1.54; p=0.80). Results remained consistent in adjusted and sensitivity analyses. LIMITATION: Analysis used real-world data that could contain errors and only considered vertical transmission associated with shared use of dialysis chairs by symptomatic patients. CONCLUSIONS: The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low. PRIMARY FUNDING SOURCE: Fresenius Medical Care North America; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067).
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