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Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients.

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.

journal_name

Infect Control Hosp Epidemiol

journal_title

Infection control and hospital epidemiology

authors

Shimokura G,Chai F,Weber DJ,Samsa GP,Xia GL,Nainan OV,Tobler LH,Busch MP,Alter MJ

doi

10.1086/659407

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

415-24

issue

eissn

0899-823X

issn

1559-6834

journal_volume

pub_type

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Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients.