Blood‐borne virus infections in dialysis units—A review

Abstract

Hepatitis outbreaks in haemodialysis unit patients and staff were reported in the late 1960s. In 1972, the Rosenheim report in the UK established guidelines which included routine tests for hepatitis B surface antigen and isolation facilities for dialysing patients with hepatitis B virus which resulted in a dramatic fall in cases of hepatitis. However, since these guidelines were introduced, other blood-borne viruses, notably HCV and HIV have been discovered, and failures of infection control practices still lead to outbreaks of HBV in haemodialysis units. The prevalence of HCV in dialysis patients varies considerably throughout the world, with reported prevalence ranging from 3·9% to 71%. The number of blood transfusions and the length of time on dialysis have consistently been associated with HCV prevalence. Several reports provide evidence of patient-to-patient HCV transmission with environmental blood contamination the most significant factor in intra-unit transmission. There is no evidence that HCV has been transmitted by re-use of dialysis machines but being dialysed next to an HCV positive patient is associated with a significant risk of HCV acquisition. Several studies have shown that dialysing HCV positive patients in a separate unit or in a defined sector of a dialysis unit significantly reduces nosocomial HCV infection. HGV is prevalent in dialysis units where there is evidence of transmission to patients but no evidence of associated symptoms. HIV is infrequently transmitted in dialysis units and several units treating many HIV-positive patients have shown no evidence of transmission. Careful attention needs to be paid to infection control procedures and regular virological testing.

Management of Hepatitis C in Patients with Chronic Kidney Disease

“…Using a third generation enzyme linked immunosorbent assay (ELISA), HCV prevalence has been reported to be between 5.5% and 10% in the United States (five times greater than the general population prevalence of 1.6%) [2], between 13.5% and 31% in Italy [3] and between 4% and 14%% in the United Kingdom [6]. Risk factors for HCV infection in HD patients include the number of blood transfusions [6], duration of ESRD [7], prevalence of HCV in dialysis units [8], history of previous organ transplantation [3,9], older [8] and younger age groups [10]. However, there has been some decrease in prevalence in developed countries over the last 20 years, with reported decline in prevalence from 24% in 1992 to 9.2% by 2002 in Spain [11].…”

Transmission of hepatitis C virus by blood transfusions and other medical procedures: A global review

“…Cases of viral hepatitis due to breaks in infection control techniques have been described among dialysed patients since the late 1960s [76]. When anti-HCV testing became available, it was observed that the prevalence of HCV in patients on dialysis varied greatly by geographic area (between 4% and 59% in different countries), and also within the same region (between 5% and 44% in different US centres) [77].…”

“…When anti-HCV testing became available, it was observed that the prevalence of HCV in patients on dialysis varied greatly by geographic area (between 4% and 59% in different countries), and also within the same region (between 5% and 44% in different US centres) [77]. The factors that were constantly reported as being associated with an increased prevalence of HCV infection were the length of time on dialysis and the number of blood transfusions [76,77]. The introduction of anti-HCV blood donor testing and the use of erythropoietin to reduce transfusion requirements has not abolished infection, but its rate of occurrence has progressively decreased [78,79].…”

Transmission of hepatitis B virus (genotype E) in a haemodialysis unit

“…In addition, HBV is stable in the environment and may survive on surfaces for days (Bond et al, 1981). Nosocomial transmission in the dialysis setting has been reported as a result of reusing multi-dose vials, staff shortages and subsequent need to care simultaneously for HBV infected and uninfected individuals and contamination of equipment and environmental surfaces (Wreghitt, 1999).…”