Equipment necessary for private room treatment of infected dialysis patients Shortage in 1/4 of hospitals

Equipment necessary for private room treatment of infected dialysis patients Shortage at 1/4 of hospitals 19:26 on July 19

When a patient undergoing artificial dialysis is infected with the novel coronavirus, it is particularly likely to be seriously ill. Therefore, dialysis treatment should be performed in a private room to prevent the infection from spreading to other patients. However, in a quarter of the hospitals that accepted these patients, the equipment required for treatment in a private room was insufficient, and there is a problem with measures to protect patients when the spread of infection reoccurs. I understand.

There are 340,000 nationwide patients undergoing dialysis due to severe kidney disease, etc., but infection with the new coronavirus easily causes severe illness, and of the 125 infected in Japan, approximately 18%, or 22 people, have died. I will.

Last month, the Japan Dialysis Medical Association and others conducted a questionnaire targeting medical institutions nationwide regarding the challenges in continuing dialysis treatment when a patient undergoing artificial dialysis becomes infected.

Treatment is required to be carried out in a private room to prevent infection to other patients, often using a special device called a “business trip dialysis machine” that can be carried, but 319 patients who received infected patients were accepted. About one-quarter of 79 hospitals said they lacked this device.

When asked about the number of vehicles needed to prepare for the spread of the infection, he found that at least 118 people were missing.

On the other hand, since the device is expensive at about 5 million yen, only 25 newly decided facilities have been decided, and it became clear that there is a problem in measures to protect patients.

"In some cases, patients were refused hospitalization in Tokyo due to a lack of equipment." It is important to create a system that can be received.” I want to ask the country for assistance.

Mortality rate of infected dialysis patients more than 4 times

It is said that patients undergoing artificial dialysis are more likely to become seriously infected if they are infected with the new coronavirus.According to a survey conducted by the Japan Dialysis Medical Association and the Japan Dialysis Medical Association, at least 22 of 125 infected people died. The mortality rate is 17.6%, which is more than four times higher than about 4% of all infected people.

Looking at the mortality rate by age group, no one
died in their 40s or below, but
5.6% in their
50s, 11.5% in their
60s, 29.7% in their 70s, and
26.9% in their 80s or older I went up.

Also,
▽3 became severe and needed treatment using the artificial heart-lung machine "ECMO",
▽19 needed artificial respiration device,
▽49 needed oxygen administration about it.

Atsushi Yao, Deputy Director of Internal Medicine, Kanto Rosai Hospital, who treated these patients, said, ``At the beginning of the hospital, only oxygen was inhaled, but my respiratory condition deteriorated immediately and I needed a ventilator the next day. He said, "I've become sick."

In addition, ``Most of the patients are elderly and have chronic diseases such as diabetes mellitus, so there is a high risk of seriousness and it is necessary to create an environment to continue dialysis treatment in a private room, so it is quite acceptable for general medical institutions. It's difficult."

General hospital that suffers

Equipment and beds are often densely arranged in large rooms at facilities that perform artificial dialysis, and patients need to be treated in such an environment for 4 to 5 hours at a time and about 3 times a week. , There is a risk of nosocomial infection.

In fact, in April, the infection spread and spread from patients who had undergone artificial dialysis to other patients and medical staff without knowing that they had been infected at central city hospitals in Kobe. It was

For this reason, medical institutions that perform artificial dialysis need to take thorough measures to prevent nosocomial infections, and we are having difficulty responding.

At a general hospital in Tokyo, from April to May, we were able to accept several patients undergoing artificial dialysis at the request of the Tokyo Metropolitan Government during a series of infections.

All the patients had mild symptoms due to the infection with the new coronavirus, but because the hospital did not have sufficient facilities, they had no choice but to perform treatment in a large dialysis room, and only for persons infected with one elevator. We decided not to overlap the movement lines of patients and the time for treatment with other patients.

In addition, patients with symptoms had a special tent in the large room that could act as a negative pressure chamber that does not leak air to the outside, and had them undergo artificial dialysis.

As a result of thorough thorough use of masks, protective clothing, and disinfection, no hospital-acquired infection has occurred so far, but if the patient is seriously ill, there is a high possibility that fine clashes will occur due to coughing, etc. Therefore, it is difficult to accept it unless it is a private room.

A doctor in charge of infection control at this hospital said, "If you cough or inhale the sputum, you will get a fine flight, so patients with such symptoms will not be accepted. I was most careful about the infection of patients and staff."

Lack of equipment at core hospitals

The National International Medical Research Center Hospital in Shinjuku-ku, Tokyo is a “specified infectious disease designated medical institution” that plays a central role in the treatment of infectious diseases in the country. I have been treated.

Of these, the one who originally received artificial dialysis was able to carry it in the hospital by using the "business trip dialysis machine", which was handled in a private room.

The device is about 1 meter high and weighs about 80 kg, and it has the function of filtering the water required by artificial dialysis, but it is expensive at about 5 million yen per unit, and there is a facility to supply and drain a large amount of water at the place to use. There are things you need to do, and there are only two.

Among the hospitalized patients, there was a case where the patient had not had kidney disease but became acute renal failure due to the infection with the new coronavirus, and a new artificial dialysis was required. I need it.

Fumihiko Hinoshita, Director of the Department of Internal Medicine of Kidney, said, "There is no predicting when or which patient will get severe, so it is necessary to have a device. However, it is rarely used except during the epidemic period of infectious diseases. As a result, we cannot afford the number of hospitals in any of the hospitals. We would like the national government and others to support us in preparation for the spread of infection."