P1538AN EXPERIENCE OF FORCED SHUTDOWN OF HEMODIALYSIS UNIT IN SOUTHERN INDIA DUE TO FLOODS
Authors: Ahmed Khan Mohammed Shoeb , Saidali Ummer , Prasannan Bipi , Kumar K Vinod , Urs Vishnu , Unni V Narayanan 
Published: June 2020

Abstract

Background and Aims
The southern state of India, Kerala was hit by the worst flood in the last century on 16.08.18, due to unprecedented monsoon rains. The Indian government had declared it a Level 3 Calamity. According to the Kerala government, over 483 people died, about a million people were evacuated. This paper describes the experience of the Hemodialysis (HD) unit at Aster Medcity, which was forcibly closed due to floods. The Nephrology department does over 1100 dialysis treatments per month and about 60 kidney transplants per year.

Aim
To study unexpected shutdown of hemodialysis unit and its effect on maintenance hemodialysis patients.

Method
This is a descriptive study of forced closure of HD unit due to floods. The sequence of events till shut down after the decision of closure has been retrospectively studied by reviewing the minutes of meetings with chief of medical services and memory recall of the Nephrology team involved in the process. Role of HD nurses during the period of flood was also studied. HD patients were interviewed and impact of floods on them was recorded, including, ability to find an alternate HD unit, any missed HD sessions, access to medicines and admissions in hospital. The characteristics of HD patients was recorded. After reopening of our HD unit, 30days assessment was done for clinical consequences including, hospitalization, infections, vascular access problems and seroconversion.

Results
The services of HD unit were suspended from midnight 17.08.18 to 27.08.18. The HD unit is at the ground floor of the hospital. The HD unit has 13 HD machines, which were used for 77 maintenance HD patients (Males: 55; Females: 22). The mean age was 61 ±14 years and the median dialysis vintage was 2 years. Vascular access was a catheter (tunnelled and non-tunnelled) in 19 patients, arterio-venous fistula in 57 patients and arterio-venous graft in 1 patient. Patients known to have Diabetes were 77.7%, Hypertension 91%, Coronary artery disease were 26 in number and chronic liver disease were 5. Hospital authorities decided to evacuate the hospital 24 hours before the floods hit the hospital premises. The Nephrology team comprised of 4 consultants, 6 residents, 33 dialysis nurses and technicians and a social worker. The HD unit was closed after draining the reverse osmosis (RO) plant at 10pm on 16.08.18. The lead consultant contacted potentially safe HD units in other parts of the state; willingness for accepting HD patients and the surge capacity of each HD unit was recorded. The HD patients were informed over telephone the centers they can approach and HD summary (includes diagnosis and HD details) was sent to them via e-mail. All HD patients were reminded to comply with diet restrictions and inform the shelter camp regarding the same. Accordingly, 77 HD patients were accommodated in 25 HD units. 12 dialysis nurses provided their services voluntarily at other HD units unaffected by floods. 15 HD patients were displaced from their homes due to floods. 19 HD patients missed one HD session; 5 HD patients missed two HD sessions; 1 patient missed three HD sessions. Our HD unit reopened on 27.08.18 after complete disinfection of the RO plant and servicing of HD machines by the manufacturer. All patients returned to our HD unit. In the first 30 days after floods, 3 patients were admitted to intensive care unit with fluid overload, 3 patients were admitted with respiratory tract infection, 2 patients had an AV fistula dysfunction, 3 patients developed catheter related blood stream infection. There was no seroconversion. There was no mortality in HD patients during and one month after flood.

Conclusion
The timely decision to suspend dialysis services played a crucial role in preparing for HD unit closure, arranging alternate HD places for patients and providing treatment summaries. However, the increase in adverse clinical consequences heralds the drop in the quality of healthcare services during natural disasters.