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Infection control of hepatitis C in Dutch dialysis centres
Insights
Dutch dialysis centers need better infection control to prevent hepatitis C virus (HCV) spread. Operating dialysis machines with potentially contaminated gloves poses a risk, highlighting the need for universal precautions regardless of HCV antibody status.
Area of Science:
- Infectious Diseases
- Hepatology
- Public Health
Background:
- Long-term dialysis and blood transfusions are known risk factors for hepatitis C virus (HCV) transmission.
- While HCV transmission via transfusion is rare due to antibody screening, nosocomial transmission within dialysis units remains a concern.
- A survey assessed current infection control measures against HCV in Dutch dialysis centers.
Discussion:
- Most centers screen new patients for HCV antibodies, but follow-up frequency varies.
- Many centers dialyze guest patients without confirmed HCV antibody status and lack precautions for unknown statuses.
- A significant percentage of centers permit nurses to operate dialysis machines with potentially blood-contaminated gloves, a practice not adequately covered by existing guidelines.
Key Insights:
- Infection control policies in Dutch dialysis centers are not yet optimal for preventing HCV transmission.
- Operating dialysis machines with potentially contaminated gloves is a significant risk factor for nosocomial HCV spread.
- Preventive strategies solely based on HCV antibody screening are insufficient due to prolonged serological window phases in dialysis patients.
Outlook:
- Universal and rigorous implementation of infection control measures, irrespective of HCV antibody status, is crucial.
- Enhanced guidelines and consistent adherence to infection control protocols are necessary to prevent nosocomial transmission of HCV and other blood-borne pathogens.
- Further research may be needed to evaluate the effectiveness of universal precautions in diverse dialysis settings.
Background:
In dialysis patients, blood transfusions and long-term dialysis are well-known risk factors for transmission of hepatitis C virus (HCV). Transmission of HCV by transfusions has become extremely rare since the introduction of antibody screening. However, nosocomial transmission of HCV within dialysis units still occurs. We performed a survey of current infection control measures against HCV in Dutch dialysis centres that had participated in a national HCV prevalence study.
Methods:
All twenty-seven Dutch dialysis centres where HCV-positive patients had been identified (HCV prevalence 1-8%), participated. With the use of a questionnaire we evaluated screening procedures for resident patients and guest patients, routine hygienic measures in HCV-positive and -negative patients, and cleaning procedures of dialysis equipment.
Results:
All centres except one screened new patients for HCV antibodies, but the frequency of periodic follow-up screening varied. Most centres requested HCV antibody screening of guest patients in advance, but in daily practice 55% of the centres dialysed guest patients even when HCV antibody status was not available. The majority of centres had not implemented special precautions for patients with unknown HCV antibody status. In most centres the use of protective glasses, masks and aprons depended on the HCV antibody status of the patients. Surprisingly, 85% of the centres allowed their nurses to operate dialysis machines with gloves possibly blood contaminated. All centres sterilized their machines at the end of the day, but only 77% sterilized their machines between all dialysis sessions. Traces of blood were removed with alcohol in 63% of the centres.
Conclusion:
Dutch dialysis centres have not yet implemented an optimal policy for prevention of HCV. Especially, operating dialysis machines with gloves might be a potential source for nosocomial transmission of HCV, not yet covered by the issued guidelines. Because dialysis patients probably have a prolonged serological window phase after a recent HCV infection, it does not suffice to implement a preventive strategy against nosocomial transmission based on the results of HCV antibody screening. Universal, rigorous implementation of adequate infection control measures irrespective of HCV antibody status should be the cornerstone for prevention of nosocomial transmission of HCV and other blood borne pathogens.