La rete dialitica ai tempi della pandemia Covid: prospettive strutturali

Risk profile of dialysis people as regards Covid 19 pandemic is unique; they stay together for some hours in an open-space, sharing transport before and after treatment as a shuttle between families and dialysis centre. As demonstrated by the waves of pandemic, isolation becomes more and more difficult, especially in centres lacking pathways and spaces devoted to contaminated patients. In our setting, dialysis centres were born as marginal areas, discarded from other uses and their design was seldom addressed to out-patients treatment. Logistic and preventive needs (spaces, distances, pathways) were often laid down to a social vision of dialysis. We describe our immediate response to adapt a network of public dialysis centres to pandemic. These measures, and the dedication of our personnel, resulted in a very low mortality rate, but we are still reporting a progressive increase of Covid patients. Organizational response becomes useless without structural changes. We therefore propose a plan oriented to transform dialysis centres into dynamic and safe places of care. Since other pandemics are expected in the future, it appears mandatory to redirect our choices towards a more conservative approach in designing a dialysis point of care, resembling the isolated pavilions of older hospital buildings. Separate entries and exits, mobile walls and large waiting rooms are needed; some personnel redundancy will be required in spite of lean management principles, strongly disproved by Covid. Dialysis rebuilding will be an extraordinary opportunity to create a sustainable way of treatment.