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Patient-Care Practices Associated with an Increased Prevalence of Hepatitis C Virus Infection among Chronic Hemodialysis Patients

Published online by Cambridge University Press:  02 January 2015

Gayle Shimokura ,
Feng Chai ,
David J. Weber ,
Gregory P. Samsa ,
Guo-liang Xia ,
Omana V. Nainan ,
Leslie H. Tobler ,
Michael P. Busch  and
Miriam J. Alter
Gayle Shimokura
Affiliation:
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina British Columbia Blood Coordinating Office, Vancouver, British Columbia, Canada
Feng Chai
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia ArQule, Inc, Woburn, Massachusetts
David J. Weber
Affiliation:
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
Gregory P. Samsa
Affiliation:
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina Department of Biostatistics and Bioinformatics, Duke Medical Center, Durham, North Carolina
Guo-liang Xia
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Omana V. Nainan
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia ArQule, Inc, Woburn, Massachusetts
Leslie H. Tobler
Affiliation:
Blood Systems Research Institute, San Francisco, California
Michael P. Busch
Affiliation:
Blood Systems Research Institute, San Francisco, California
Miriam J. Alter*
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
*
University of Texas Medical Branch, 301 University Boulevard, Mail Route 0435, Galveston, TX 77555-0435 (mjalter@utmb.edu)
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Abstract

Objective.

To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients.

Design.

Survey.

Setting.

Chronic hemodialysis facilities in the United States.

Participants.

Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30–150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate.

Methods.

Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation.

Results.

The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%–11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4–3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3–3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0–2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8–5.2]), patient-to-staff ratio of at least 7: 1 (OR, 2.4 [95% CI, 1.4–4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3–4.4]).

Conclusions.

This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 5 , May 2011 , pp. 415 - 424
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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Footnotes

b

Deceased

References

1. Davis, GL, Alter, MJ, El-Serag, H, Poynard, T, Jennings, LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology 2010;138:513–521.CrossRefGoogle ScholarPubMed
2. Armstrong, GL, Wasley, A, Simard, EP, McQuillan, GM, Kuhnert, WL, Alter, MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705–714.CrossRefGoogle ScholarPubMed
3. Finelli, L, Miller, JT, Tokars, JI, Alter, MJ, Arduino, MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005;18:52–61.CrossRefGoogle ScholarPubMed
4. Fabrizi, F, Takkouche, B, Lunghi, G, Dixit, V, Messa, P, Martin, P. The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 2007;14:697–703.CrossRefGoogle ScholarPubMed
5. Maluf, DG, Fisher, RA, King, AL, et al. Hepatitis C virus infection and kidney transplantation: predictors of patient and graft survival. Transplantation 2007;83:853–857.CrossRefGoogle ScholarPubMed
6. Terrault, NA, Adey, DB. The kidney transplant recipient with hepatitis C infection: pre- and posttransplantation treatment. Clin J Am Soc Nephrol 2007;2:563–575.CrossRefGoogle ScholarPubMed
7. Centers for Disease Control and Prevention. Hepatitis C virus transmission at an outpatient hemodialysis unit—New York, 2001–2008. MMWR Morb Mortal Wkly Rep 2009;58:189–194.Google Scholar
8. Saab, S, Martin, P, Brezina, M, Gitnick, G, Yee, HF Jr. Serum alanine aminotransferase in hepatitis C screening of patients on hemodialysis. Am J Kidney Dis 2001;37:308–315.CrossRefGoogle ScholarPubMed
9. Thompson, ND, Novak, RT, Datta, D, et al. Hepatitis C virus transmission in hemodialysis units: importance of infection control practices and aseptic technique. Infect Control Hosp Epidemiol 2009;30:900–903.CrossRefGoogle ScholarPubMed
10. Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50:1–45.Google Scholar
11. Centers for Disease Control. Hepatitis: control measures for hepatitis B in dialysis centers. HEW publication no. (CDC) 788358 (Viral Hepatitis Investigations and Control Series). 1977.Google Scholar
12. Centers for Medicare and Medicaid Services. National listing of Medicare providers furnishing kidney dialysis and transplant services. Washington, DC: Government Printing Office, 2000.Google Scholar
13. Page-Shafer, K, Pappalardo, BL, Tobler, LH, et al. Testing strategy to identify cases of acute hepatitis C virus (HCV) infection and to project HCV incidence rates. J Clin Microbiol 2008;46:499–506.CrossRefGoogle ScholarPubMed
14. Devereux, J, Haeberli, P, Smithies, O. A comprehensive set of sequence analysis programs for the VAX. Nucleic Acids Res 1984;12:387–395.CrossRefGoogle ScholarPubMed
15. Cody, SH, Nainan, OV, Garfein, RS, et al. Hepatitis C virus transmission from an anesthesiologist to a patient. Arch Intern Med 2002;162:345–350.CrossRefGoogle ScholarPubMed
16. Felsenstein, J. Estimating effective population size from samples of sequences: a bootstrap Monte Carlo integration method. Genet Res 1992;60:209–220.CrossRefGoogle ScholarPubMed
17. US Renal Data System. USRDS 2001 annual data report: atlas of end-stage renal disease in the United States. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 2001.Google Scholar
18. Ramili, S, Krawczynski, K, McCaustland, K, Li, X, Alter, MJ. In-fectivity of hepatitis C virus in plasma after drying and storing at room temperature. Infect Control Hosp Epidemiol 2007;28:519–524.Google Scholar
19. Carducci, A, Verani, M, Casini, B, et al. Detection and potential indicators of the presence of hepatitis C virus on surfaces in hospital settings. Lett Appi Microbiol 2002;34:189–193.CrossRefGoogle ScholarPubMed
20. Froio, N, Nicastri, E, Comandini, UV, et al. Contamination by hepatitis B and C viruses in the dialysis Setting. Am J Kidney Dis 2003;42:546–550.CrossRefGoogle Scholar
21. Girou, E, Chevaliez, S, Challine, D, et al. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Clin Infect Dis 2008;47:627–633.CrossRefGoogle Scholar
22. Simjanovska, LJ, Porcu, K, Amitov, V, Efremov, GD, Polenakovic, M. Reverse transcriptase/polymerase chain reaction analyses of hemodialysis ultrafiltrates and sera of hepatitis C virus positive patients. Int J Artif Organs 2004;27:35–39.CrossRefGoogle ScholarPubMed
23. Bond, WW, Favero, MS, Petersen, NJ, Gravelle, CR, Ebert, JW, Maynard, JE. Survival of hepatitis B virus after drying and storage for one week. Lancet 1981;1:550–551.CrossRefGoogle ScholarPubMed
24. Laporte, F, Tap, G, Jaafar, A, et al. Mathematical modeling of hepatitis C virus transmission in hemodialysis. Am J Infect Control 2009;37:403–407.CrossRefGoogle ScholarPubMed
25. Savey, A, Simon, F, Izopet, J, Lepoutre, A, Fabry, J, Desenclos, JC. A large nosocomial outbreak of hepatitis C virus infections at a hemodialysis center. Infect Control Hosp Epidemiol 2005;26:752–760.CrossRefGoogle Scholar
26. Fissell, RB, Bragg-Gresham, JL, Woods, JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65:2335–2342.CrossRefGoogle ScholarPubMed
27. Izopet, J, Sandres-Saune, K, Kamar, N, et al. Incidence of HCV infection in French hemodialysis units: a prospective study. J Med Virol 2005;77:70–76.CrossRefGoogle ScholarPubMed
28. Petrosillo, N, Gilli, P, Serraino, D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001;37:1004–1010.CrossRefGoogle ScholarPubMed
29. Sivapalasingam, S, Malak, SF, Sullivan, IF, Lorch, J, Sepkowitz, KA. High prevalence of hepatitis C infection among patients receiving hemodialysis at an urban dialysis center. Infect Control Hosp Epidemiol 2002;23:319–324.CrossRefGoogle ScholarPubMed
30. Shimokura, G, Weber, DJ, Miller, WC, Wurtzel, H, Alter, MJ. Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff. Am J Infect Control 2006;34:100–107.CrossRefGoogle ScholarPubMed
31. Fabrizi, F, Messa, P, Martin, P. Transmission of hepatitis C virus infection in hemodialysis: current concepts. Int J Artif Organs 2008;31:1004–1016.CrossRefGoogle ScholarPubMed
32. Delarocque-Astagneau, E, Baffoy, N, Thiers, V, et al. Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine? Infect Control Hosp Epidemiol 2002;23:328–334.CrossRefGoogle Scholar
33. Tu, AW, Buxton, JA, Whidock, M, et al. Prevalence and incidence of hepatitis C virus in hemodialysis patients in British Columbia: follow-up after a possible breach in hemodialysis machines. Can J Infect Dis Med Microbiol 2009;20:e19–e23.CrossRefGoogle ScholarPubMed
34. Centers for Disease Control and Prevention. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. MMWR Recomm Rep 2003;52:1–13.Google Scholar
35. Ghafur, A, Raza, M, Labbett, W, et al. Travel-associated acquisition of hepatitis C virus infection in patients receiving haemodialysis. Nephrol Dial Transplant 2007;22:2640–2644.CrossRefGoogle ScholarPubMed
36. Glynn, SA, Wright, DJ, Kleinman, SH, et al. Dynamics of viremia in early hepatitis C virus infection. Transfusion 2005;45:994–1002.CrossRefGoogle ScholarPubMed
37. Orton, SL, Stramer, SL, Dodd, RY, Alter, MJ. Risk factors for HCV infection among blood donors confirmed to be positive for the presence of HCV RNA and not reactive for the presence of anti-HCV. Transfusion 2004;44:275–281.CrossRefGoogle Scholar
38. O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001;29:352–360.CrossRefGoogle ScholarPubMed
39. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention Web site, http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed March 20, 2010.Google Scholar
40. Centers for Disease Control and Prevention. Infection control requirements for dialysis facilities and clarification regarding guidance on parenteral medication vials. MMWR Morb Mortal Wkly Rep 2008;57:875–876.Google Scholar