## 3 Results
### Outcomes of COVID-19 Confirmed HD Patients  
Two of the 497 HD patients had persistent positive weekly rapid test results for more than 4 weeks; however, no presence of fever or clinical symptoms were noted in these two cases. The weekly RT-PCR testing for them was all negative. One single confirmed patient of our HD unit transmitted from the household developed severe pneumonia, while she responded well to therapy, survived, and was eventually discharged. In contrast, eight confirmed HD cases of infection were noted in a neighborhood HD unit at Keelung using \begin{table}
\begin{tabular}{p{142.3 pt} p{284.5 pt}} \hline \hline
**Strategies** & **Contents of Measures** \\ \hline \multirow{4}{*}{Space segmentation} & Use of solid compartment to separate the open room into cabins of 8–10 beds, using wood, strengthened glass, and acrylic as materials. \\  & Use of acrylic partitions in the nursing station to limit droplet dissemination. \\  & Fixed care bundle: fixed patients and caregivers in pre-established bed or seat location cared by a fixed nursing team using fixed clinical carts. \\  & Installation of monitoring and loudspeaker system in negative pressure isolation room to limit frequent entries and exits of personnel. \\ \hline \multirow{4}{*}{Access control} & Spacing between exchanges of HD sessions to avoid overlapping of patients at entry and exit of HD room. \\  & Double TOCC checking at both entry of hospital (by reading of NHI card) and at the door of HD unit (by personal verbal and written confirmation). \\  & Double-checking of clinical symptom and body temperature at both entry of hospital and at the door of HD unit. \\  & Double hand alcohol disinfection at both entry of hospital and at door of HD unit. \\  & Remove tables and chairs in the waiting area and set up a position mark on the ground of entry with 1.5 m of distancing to avoid clustering. \\  & Control of the total number of people in the hospital and in a single elevator. \\ \hline \multirow{4}{*}{Quarantine operations} & Postering and broadcasting (at entry of HD room, in the beginning of every HD session) of our HD preventive measures. \\  & Caregiver limitation (do not stay in treatment area, or fixed caregiver if assistance needed) \\  & Weekly rapid nasopharyngeal swab SARS-CoV-2 antigen testing for patients and fixed caregivers. \\  & Acceptance of new patients into our HD unit is prohibited during an outbreak. Triage algorithm should be followed for emergent cases (see Figure 3). \\  & Bedside vaccination program for all HD patients. \\ \hline \multirow{4}{*}{Staff protection} & All medical and nursing staff wore high-quality PPE, including face shields, goggles, N95 masks, gloves, and waterproof isolation gowns. \\  & Staff entering the dialysis room must perform a QR code scan to confirm location and contact tracking. \\  & Provide the first dose of COVID-19 vaccine to all of the staff before the end of May. \\  & Staff who take care of confirmed patients should receive RT-PCR testing on a weekly basis. \\ \hline \hline \end{tabular} All these measures were implemented in addition to those recommended by the Taiwan CDC and TSN. Abbreviations: HD, hemodialysis; TOCC, travel, occupation, contact, cluster history; NHI, national health insurance; PPE, personnel protection equipment; QR code, Quick Response code; COVID-19, coronavirus infection disease 2019; RT-PCR, real-time polymerase chain reaction.  
\end{table} 
Table 3: Specific COVID-19 prevention measures of the Dialysis Center of CGMH, Keelung Branch in 2021.  
only universal preventive measures of the CDC (Table 2). One of these patients died prior to admission to our hospital and five of them died after admission to our intensive care unit. Table 4 shows the characteristics of SARS-CoV-2 infection confirmed HD patients of Keelung City admitted to our hospital. Overall, nine confirmed HD cases were found at Keelung and the mortality rate was 66.6% (6 of 9). The median \(\mathrm{C_{t}}\) value of hospitalized patients was 17.53 (11.75-27.90) upon diagnosis.