Prevention of viral transmission in HD units: the value of isolation.

We have investigated the influence of isolation of patients with different viral serology status on the transmission of viral hepatitis among patients on hemodialysis (HD). Our kidney center was designed to facilitate isolation of infected patients and implement infection control pre-cautions. These included separate rooms, separate entrances and exit sites, and designated HD machines for patients with hepatitis B, hepatitis C, and sero-negative patients. In addition, universal infection control polices and procedures were implemented. These included proper chemical and heat disinfection of all HD machines following each HD session. These measures were complemented with education and training of the nursing staff detailing strict adherence to all infection control policies and procedures. All of our patients and staff were vaccinated against hepatitis B. Our results showed that after four years of follow-up, there was a decrease in the annual incidence of hepatitis C seroconversion from an average of 2.4% to 0.2%. The current prevalence of hepatitis C is 29% compared to 57% at the start of the study. In addition, there have been no reported sero-conversion cases of hepatitis B. Furthermore, our data also confirmed that the prevalence of hepatitis C (as well as hepatitis B) is more frequent in HD (29%) than peritoneal dialysis (5%) units. Surgical procedures, blood transfusion, and frequent visits to different dialysis units remain the major risk factors for contracting viral hepatitis. In conclusion, these results clearly show that isolation of patients and machines, together with strict adherence to infection control policies and procedures, result in a significant decline in the incidence and prevalence and better control of viral hepatitis transmission among HD patients.