Organization

National Kidney and Transplant Institute

Best Practice Focus Area/s

Leadership, Citizens / Customers, Operations

Year Implemented

July 2021

This is a GBPR entry

Summary

The NKTI COVID Modular Hemodialysis (HD) unit was established to address the shortage of HD centers in NCR capable of accommodating COVID confirmed End Stage Kidney Disease (ESKD) cases. The need for an HD facility for COVID-positive outpatients only was recognized. It was carefully planned to provide safe HD in an infection-controlled environment. It was designed with individual patient cubicles for HD, donning and doffing areas for personal protective equipment, shower rooms for staff, and separate entrance and exit areas. This became the 20-station NKTI COVID Modular HD Unit, built by the DPWH at no cost to the NKTI. This was part of the “whole government approach” in dealing with the pandemic’s challenges. The facility was inaugurated on May 5, 2021, the first in the country. This facility provided the breathing space for the main hospital’s HD Unit that went back to delivering urgent HD support for admitted and ER patients.

Background and Problem

With the COVID pandemic kickoff in March 2020, HD centers in the NCR saw a steady increase in the number of COVID cases and suspects among their prevalent dialysis patients. The inadequacy of the available personal protective equipment (PPEs), isolation rooms, proper air exchanges/ventilation in most HD centers; the uncertainty of the course and treatment of the disease early in the pandemic; and then, coupled later, with staff resignation (specific nurses) primarily due to fear and fatigue, led to the inability or refusal of these dialysis centers to accommodate their patients who became COVID suspects or confirmed cases. These patients missed their regular HD sessions, developed congestion and uremia and scouted far and wide for HD centers that temporarily accommodate them while battling SARSCOV2 lest they face mortality. Many of them found themselves knocking on the doors of the NKTI ER and NKTI HD Unit. These displaced non-NKTI ESKD patients who were eventually accommodated by NKTI significantly outnumbered NKTI’s regular HD patients.

The NKTI put up about 26 tents for its HD unit all over its Emergency Room parking areas and driveways to serve 100 covid suspects and confirmed patients while the hospital was retrofitting its wards to accept patients with this infectious virus while keeping the HCWs safe. There were 3 HD tents with about 19 HD machines and several portable reverse osmosis machines for water treatment. When the rainy season came, these tents were slowly dismantled, and patients were transferred to the main hospital. Patients requiring HD from the ER and hospital wards were all accommodated in the main hospital’s HD Unit. With the increase in COVID patients coming to the NKTI, the main hospital’s HD Unit became overwhelmed. HD treatment times were shortened to enable all patients to undergo HD on their scheduled date, with some patients experiencing delays of up to 24 hours. Additional temporary HD stations were placed on the hospital’s 3rd floor and another on the transplant floor to address this need. As patients recovered from COVID, they needed to have a negative COVID RT-PCR test before re-acceptance to their chronic HD facility for non-COVID patients. COVID-recovered patients needed up to 3 weeks of quarantine before returning to their HD facilities. The need for a separate facility to dialyze these patients.

The Department of Public Works and Highways has formally turned-over on last 5 May 2021 the first off-site modular hemodialysis facility completed at the National Kidney and Transplant Institute (NKTI).

Solution and Impact

The permanent solution was building a separate HD facility for COVID patients. This would relieve the burden on the hospital’s main HD Unit in dialyzing COVID-recovering patients or those still in quarantine since their original HD facilities will not accept them. A separate HD facility for COVID patients would allow the main HD Unit to dialyze only critical patients admitted or at the ER rather than squeeze dialyzing even recovered outpatients. NKTI’s top management consulted with the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) and the Department of Public Works and Highways (DPWH) to see if they could build this facility for the NKTI at the soonest possible time to address this urgent need. Both agencies agreed to assist the Institute, and NKTI allocated space for this facility. It took several weeks of planning with NKTI’s HD Leaders for the specifications of HD provision, discussions with the Infection and Prevention and Control Unit to ensure that the building specifications met the safety requirements for treating COVID patients, and meetings with the NKTI general services division.

The government-to-government mode of procurement under the COVID emergency allowed immediate construction of the facility. The NKTI went through the bidding process for the provision of HD services for one year, which was successfully awarded. On 5 May 2021, building turnover to NKTI was done by DPWH in simple rites at the facility attended by the Mayor of Quezon City, Secretaries of the Departments of Health, DPWH, and IATF. This project was another first for NKTI and the country, where a separate HD facility for COVID patients was built. Many hospitals were given additional HD machines for their COVID patients, but this is the first HD facility constructed for only COVID patients.

The NKTI COVID Modular HD unit has resulted in numerous benefits. An ideal facility with isolation rooms for every patient, adequate air exchanges and areas for donning and doffing for PPE, including shower areas for the staff, and separate entrance and exit areas in this 20-HD station facility was met with satisfied patients and HCWs. A separate adjacent dormitory was also built, and HCWs on regular duty at the COVID modular HD facility were provided rooms. COVID-recovering patients from all over NCR now have a facility of their own. No patient is left without a place to have this lifesaving treatment. The provision of dialysis has been NKTI’s core service, and no stone is left unturned for NKTI to deliver this promise to its patients with ESKD. This project was a very successful example of the government working together for the common purpose of serving the dialysis population.

Milestones

Efforts to completely and effectively cohort COVID suspects and confirmed cases eventually led to establishing the country’s biggest and most ideal dedicated outpatient COVID HD unit. This is the NKTI COVID Modular HD unit with its clearly defined COVID protocols. It has twenty (20) HD stations that can run a maximum of four (4) shifts per day. It can cater to a maximum of eighty (80) patients daily. This facility addressed the HD needs of many COVID ESKD patients in the NCR.

There were two parallel activities required to operate this facility:

  1. Construction of the HD facility via government-to-government procurement; and
  2. Procurement of the HD services for this facility for one year.

These activities were simultaneously done due to the immediate demand for a facility for the increasing number of COVID renal patients. The facility started its operations in July 2021.