In response to the novel coronavirus, CMS is supplementing its guidance to dialysis facilities on interacting with patients.
The memoranda, released March 10, was developed from frequently asked questions about interacting with patients amid COVID-19, the agency said in a statement.
“The guidance offers clear, actionable information to health care workers on the screening, treatment and transfer procedures to follow when interacting with patients,” according to a CMS press release.
“We are arming our providers on the front lines with the information they need to remain safe, while giving quality care to their patients,” CMS Administrator Seema Verma said in the release. “Today’s guidance will help providers identify patients who may have contracted the disease and minimize further transmission. It will also equip them to get these patients the medical care they need in order to recover.”
The guidance aims to help control and prevent the spread of infection, CMS said.
“In particular, the new guidance advises all Medicare-enrolled dialysis facilities to identify high risk individuals prior to appointments or upon arrival, and immediately begin screening for fever or symptoms of a respiratory infection, such as a cough and sore throat ... ,” the agency wrote.
Patients with symptoms of a respiratory infection should put on a facemask and check-in and keep it on until they leave the facility, the agency said it is guidance.
“Patients should inform staff of fever or respiratory symptoms immediately upon arrival at the facility (eg, when they check in at the registration desk) ... Have patients call ahead to report fever or respiratory symptoms so the facility can be prepared for their arrival or triage them to a more appropriate setting (eg, an acute care hospital),” according to the guidance.
“Facilities should also provide patients and staff with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette,” CMS said.
“Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.”
Dialysis staff who have signs and symptoms of a respiratory infection should not report to work, CMS said.
“Facilities should implement sick leave policies that are nonpunitive, flexible and consistent with public health policies that allow ill staff members to stay home,” the agency said. “Any staff member that develops signs and symptoms of a respiratory infection should immediately stop work (if working), put on a facemask, and self-isolate at home ... ”
Facilities should also have space in waiting areas for ill patients to sit separated from other patients by at least 6 feet, the guidance said.
“Medically stable patients who do not have other care needs have the option to wait in a personal vehicle or outside the health care facility where they can be contacted by mobile phone when it is their turn to be seen,” CMS said.
“Ideally, symptomatic patients would be dialyzed in a separate room (if available) with the door closed,” CMS added.
Hepatitis B isolation rooms may be used to dialyze patients if the patient with suspected or confirmed COVID-19 is hepatitis B surface antigen positive or the facility has no hepatitis B surface antigen positive patients who would require treatment in the isolation room, the agency said.