Low Prevalence of Hepatitis C Virus Infection in Hemodialysis Units: Effect of Isolation?

Abstract

Hepatitis C virus (HCV) infection has recently become the major cause of chronic liver disease among patients on chronic hemodialysis. The use of erythropoietin for treatment of anemia has reduced the number of blood transfusions, but the frequency of HCV infection has not declined in hemodialysis units. The exact mode of transmission of HCV within dialysis units is as yet incompletely defined, but there is evidence to support nosocomial transmission by sharing dialysis machines in the hemodialysis unit. We performed a study to estimate the prevalence of HCV infection in our hemodialysis unit and to evaluate the effect of patient isolation and use of devoted dialysis machines for HCV-positive patients on the spread of HCV infection. A total of 168 patients on chronic hemodialysis (92 males and 76 females; mean age 54 +/- 12) were screened for HCV-antibodies (HCV-Ab) before their admission to the dialysis unit. Seropositive patients were isolated and confined to dedicated dialysis machines. Aminotransferases were measured monthly and HCV-Ab screening was performed second or third generation ELISA test every two months. Seropositive patients were tested by the PCR for the detection of HCV-RNA. Between March 1992 and August 2000, eight of 168 patients showed seroconversion. Seropositive patients were also found HCV-RNA positive. Four of these patients have become seropositive after they had undergone hemodialysis in other dialysis centers on holiday, two patients had received blood transfusions within the six months preceding seroconversion. The prevalence of HCV positivity in our hemodialysis unit is 4.7%. The low prevalence of HCV infection of our unit suggests that patient isolation and use of dedicated dialysis machines for seropositive patients decrease the transmission of HCV infection in hemodialysis units.

Is Pre-Endoscopy Hepatitis B and C Testing Useful?

“…Due to the risk of transmission of hepatitis in the many dialysis centers around the world, dialysis machines used by patients with hepatitis, and even their rooms, are separated from other patients (14,15). However, no such separation of endoscopy devices, which are in direct contact with patient blood and secretions, is undertaken, even though such equipment may, in fact, have a higher risk of transmission than dialysis machines.…”

Hepatitis C in Hemodialysis Patients: Current Global Magnitude, Natural History, Diagnostic Difficulties, and Preventive Measures

“…Lack of strict adherence to universal precautions by staff and sharing of articles such as multidose drugs might be the main mode of nosocomial HCV spread among HD patients [31, 65, 147, 149, 150,152,153,154]. Although some studies found that nosocomial spread of HCV declined when HCV-infected patients were treated in dedicated HD units [12,13,14,15,16,17, 41, 155], other investigators could control nosocomial spread of HCV among HD patients by strict application of hygienic precautions without isolation of HCV-infected subjects or machine segregation [56, 152, 156]. Indeed, the presented efficacy of segregation policy and use of dedicated units for HCV-infected patients might be simply due to the prevention of article sharing between patients and might reflect a better implementation of other hygienic precautions.…”

Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil

“…Some of these advances were the introduction of recombinant erythropoietin for the treatment of anemia that eliminated the need for regular blood transfusion, the routine anti-HCV screening test implemented at the blood centers preventing the transfusion route of HCV transmission, the modernization of new dialysis equipment, and the requirement of periodic anti-HCV screening of all patients undergoing hemodialysis treatment that permitted the individualization of treatment. Calabrese et al (28) and others (29) showed that by dialyzing HCV-positive patients using separate equipment in a dedicated area (but not a separate room) led to a striking reduction in the incidence of HCV infection.…”