Joint statement from professional and patient societies on dialysis away from base.
With the decrease in the number of individuals with COVID-19 in the UK and the changes in national guidance including lifting of lockdown and a focus on individualised risk assessment we have been asked to provide a guidance statement on dialysis away from base (DAFB). This guidance does not apply if shielding or a requirement for self-isolation is in place.
Recognising the benefits to those on dialysis and their families, units are encouraged to consider how and when to restart DAFB, in line with local policies and an assessment of the risks. We recommend that dialysis away from base (DAFB) should be discussed on an individualised basis between the patient and their clinical team using the principles stated below. Patients and clinical staff need to remain vigilant as patients receiving dialysis are highly vulnerable if they sustain COVID-19 infection.
This guidance applies to patients who are receiving haemodialysis and peritoneal dialysis. Modality specific advice is given where indicated.
1. Assess based on the current incidence of COVID-19 in the base unit and locality and the designated unit/locality for DAFB. Information for locality specific rates can be accessed at https://coronavirudata.gov.uk/
2. Patients should be advised not to travel if there has been close contact with an individual who has tested positive for COVID-19 and is following government guidelines for self-isolation, currently 14 days with no symptoms https://www.nhuk/conditions/coronavirus-covid-19/self-isolation-and- treatment/when-to-self-isolate-and-what-to-do/
3. Patient.who are receiving in centre or satellite unit haemodialysis should be advised not travel if there has been a COVID-19 infection within 14 days of any patient or staff member on the day of dialysis on the base unit or DAFB unit.
4. Patients should be advised not to travel if they have symptoms of COVID-19 or a swab has been taken for COVID-19 and the result is awaited.
5. If surgery is planned within two weeks then there should be no travel as patients will be asked to self-isolate for 14 days before the operation.
6. A COVID-19 swab should be undertaken within 7 days of travel. For travel to proceed this swab must be –ve for COVID-
7. For patients receiving haemodialysis ensure that there is a documented discussion between the clinical staff at the base unit and the DAFB centre for shared awareness of COVID-19 rates and confirmation of no recent COVID-19 infections in the base unit or receiving service. Ensure the patient is aware in advance of the local protocols that they will need to follow, e.g. wearing a mask, eating and drinking during dialysis.
8. For patients undergoing peritoneal dialysis follow local unit guidance and consider undertaking a risk assessment prior to travelling. Check availability of fluid deliveries and facilities at destination are suitable to carry out peritoneal dialysis safely.
9. For caravan dialysis ensure that the relevant guidance on hand hygiene, staff PPE and cleaning is followed as outlined in the recently published recommendations for minimising the risk of transmission of COVID-19 in UK adult haemodialysis units. https://renal.org/wp- content/uploads/2020/07/Recommendations-for-minimising-risk-of- transmission-of-COVID-19-on-UK-ha.._.pdf
10. Follow the guidance for high risk individuals in the DAFB locality. This guidance is likely to vary with time.
11. On return, patients should dialyse in isolation for 14 days from date of return to the Patients should have a negative COVID-19 swab before returning to their usual dialysis unit.
12. This advice applies irrespective of the DAFB type and destination.
13. Check what is covered by travel insurance in the event of an infection with COVID-19 just before or during the holiday.
14. The Foreign and Commonwealth Office (FCO) previously advised against all but essential international travel. The guidance https://www.gov.uk/guidance/coronavirus-covid-19-countries-and-territories- exempt-from-advice-against-all-but-essential-international-travel has now been changed and travel is possible to countries which are assessed as no longer presenting an unacceptably high risk to British people travelling abroad. However, the FCO note that the pandemic is still ongoing and disruption is still possible.
15. More information about insurance coverage for cancelled trips can be found on the Associate of British Insurers website https://www.abi.oruk/products-and- issues/topics-and-issues/coronavirus-hub/.