Strict measures needed to halt HCV in hemodialysis

ICPs must go beyond standard precautions

Intensive efforts must be made to educate new staff and reeducate existing staff regarding hemodialysis-specific infection control practices that prevent transmission of HCV and other bloodborne pathogens, the Centers for Disease Control and Prevention emphasizes.1

Nosocomial transmission of HCV may occur in hemodialysis centers if infection control techniques or disinfection procedures are inadequate and contaminated equipment is shared among patients. Hemodialysis-center precautions are more stringent than standard infection control precautions, which require use of gloves only when touching blood, body fluids, secretions, excretions, or contaminated items. In contrast, hemodialysis-center precautions require glove use whenever patients or hemodialysis equipment are touched.

Standard precautions do not restrict use of supplies, instruments, and medications to a single patient. In contrast, hemodialysis-center precautions specify that none of those items be shared among any patients. The CDC recommends the following routine infection control precautions for the care of all hemodialysis patients to prevent nosocomial transmission of hepatitis C virus and other bloodborne pathogens:

• Patients should have specific dialysis stations assigned to them, and chairs and beds should be cleaned after each use.

• Sharing among patients of ancillary supplies such as trays, blood pressure cuffs, clamps, scissors, and other nondisposable items should be avoided.

• Nondisposable items should be cleaned or disinfected appropriately between uses.

• Medications and supplies should not be shared among patients, and medication carts should not be used.

• Medications should be prepared and distributed from a centralized area.

• Clean and contaminated areas should be separated (e.g., handling and storage of medications and hand washing should not be done in the same or an adjacent area to that where used equipment or blood samples are handled).

Reference

1. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998; 47 (No. RR-19):1-39.