NKF: HCV Outbreaks at Dialysis Units Linked to Outmoded Infection Control

[okarol]

NKF: HCV Outbreaks at Dialysis Units Linked to Outmoded Infection Control
By Charles Bankhead, Staff Writer, MedPage Today
Published: April 07, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
DALLAS, April 7 -- Four outbreaks of hepatitis C at dialysis centers were caused by infection control practices that disregarded CDC recommendations, according to an investigation by the agency.

Each outbreak was associated with at least two and as many as six practices that did not conform to CDC recommendations for infection control at dialysis centers, the agency's Nicola Thompson, Ph.D., reported at the National Kidney Foundation's spring clinical meetings here.

Practices commonly associated with HCV infection at dialysis centers include re-use of IV medication vials and contamination of equipment and the environment by use of mobile carts and inadequate cleaning, she noted.
Action Points 

    * Explain to interested patients that failure to follow infection control recommendations was implicated in outbreaks of HCV infection at dialysis facilities.

"The risk of hepatitis C transmission in dialysis facilities, as well as hepatitis B and HIV, has decreased over the past decade as a result of better infection control practices," said Dr. Thompson. "However, we're finding that outbreaks continue to occur despite the recommendations for enhanced infection control."

Only one of the outbreaks occurred after implementation of the CDC's most recent infection-control recommendations in 2001, she added.

Hemodialysis patients have a five-fold greater prevalence of HCV infection compared with the general population (8% to 10% versus 1.8%).

The four outbreaks occurred from 1998 to 2006. In each case CDC investigators collected and tested specimens from the dialysis facilities, reviewed patient records, interviewed patients and staffers, and performed an on-site environmental assessment of each facility.

Current CDC recommendations for infection control at hemodialysis facilities include:

    * Routine HCV testing of all patients on admission and every six months
    * Use of single-dose medication vials, defined as one use for one patient and use of sterile needles and syringes.
    * Storage and preparation of IV medications away from treatment areas.
    * Prohibition of mobile carts for delivery of medications or supplies to patient stations.
    * Thorough cleaning and disinfection of stations between patients.

The review showed that prevalence of chronic HCV infection ranged between 4% and 36% at dialysis facilities involved in the four outbreaks. The rate of new infections arising during the outbreaks ranged from 8% to 18%.

Practices associated with two or more outbreaks were:

    * Use of mobile medication carts
    * Failure to clean dialysis machines or stations surfaces
    * Re-use of medication vials
    * Use of a dialysis machine immediately after treatment of a patient with chronic HCV infection
    * Dialysis at a station next to a patient with chronic HCV infection

Dr. Johnson reported no disclosures.

Primary source: National Kidney Foundation Meeting 2008
Source reference:
Thompson N, et al "Hepatitis C virus (HCV) transmission in the hemodialysis setting: importance of infection control practices and aseptic technique" NKF Meeting 2008; Abstract 180.

Complete NKF Coverage
 
 
 
Find this article at:
http://www.medpagetoday.com/MeetingCoverage/NKF/tb/9027