Clinical practice guideline management of blood borne viruses within the haemodialysis unit

Abstract

Some people who are receiving dialysis treatment have virus infection such as hepatitis B, hepatitis C and/or HIV that is present in their blood. These infections can be transmitted to other patients if blood is contaminated by the blood of another with a viral infection. Haemodialysis is performed by passing blood from a patient through a dialysis machine, and multiple patients receive dialysis within a dialysis unit. Therefore, there is a risk that these viruses may be transmitted around the dialysis session. This documents sets out recommendations for minimising this risk.There are sections describing how machines and equipment should be cleaned between patients. There are also recommendations for dialysing patients with hepatitis B away from patients who do not have hepatitis B. Patients should be immunised against hepatitis B, ideally before starting dialysis if this is possible. There are guidelines on how and when to do this, for checking whether immunisation is effective, and for administering booster doses of vaccine. Finally there is a section on the measures that should be taken if a patient receiving dialysis is identified as having a new infection of hepatitis B, hepatitis C or HIV.

Viral hepatitis in patients on hemodialysis

“…These isolation measures were credited with the reduction of HBV transmission by 70%‐80% in HD units 23 . Studies in multiple other countries concur that isolation decreases transmission 2,17,24 . Incidence of HBV in HD units decreased from 6.2% in 1974, to 1% in 1980, to 0.06% in 1999 6 .…”

“…Even in the absence of visible blood, HBV can remain infectious on environmental surfaces for at least 7 days, 6,12,13 and HCV can live in dried blood spots to be infectious from days to weeks 14‐16 . The risk that a nonimmune individual with an untreated percutaneous exposure to an HBV‐infected source will seroconvert is as high as 30%; by contrast, the risk for HCV is 1.8% 17 …”

“…Hepatitis D and G infections are also more common among dialysis patients than in the general population. However, in contrast to HBV and HCV, the clinical consequences of HDV and HGV in dialysis patients is unknown 6,17 …”

“…Outbreaks of viral hepatitis in HD units can usually be traced to breaches in the implementation of infection control measures. Often, multiple breaches across multiple infection control categories are found 12,17,21,25,27,33 . Only a handful of cases of HCV transmission via internal machine pathways have been reported.…”

“…HBsAb can wane over time and thus should be checked annually if the patient was HBsAb‐positive but HBcAb‐negative (ie, immune due to prior vaccine) 6 . Some patients with prior infection have isolated HBcAb‐positive with HBsAb‐negative and HBsAg‐negative, and should be checked for HBV viral load to see if they have chronic or cleared infection 17 …”