Dialysis providers and facilities are urged to assess and improve infection control practices to stop hepatitis C virus (HCV) transmission among patients undergoing hemodialysis, according to a Pennsylvania Department of Health (DOH) advisory issued on Jan. 28, 2016. The advisory was originally distributed by the Centers for Disease Control and Prevention (CDC).
There has been an increase in the number of reports of newly acquired hepatitis C virus (HCV) infection among patients undergoing hemodialysis. Infection control lapses in dialysis care could expose patients to HCV. Any case of new HCV infection in a patient undergoing hemodialysis should prompt immediate action.
Dialysis providers and facilities should take these four steps whether or not they are aware of infections in their clinic:
- Assess current infection control practices and environmental cleaning and disinfection practices within the facility to ensure adherence to infection control standards
- Address any gaps identified by the assessments
- Screen patients for HCV, following CDC guidelines, to detect infections, determine treatment potential, and halt secondary transmission
- Promptly report all acute HCV infections to the state or local health department.
Background: Why the Alert Was Issued
Between 2014 and 2015, the CDC has been contacted about 36 cases of acute HCV infection in 19 different hemodialysis clinics in eight states. While investigations are ongoing, HCV transmission between patients has been demonstrated at nine of those clinics, based on epidemiologic and viral sequencing evidence.
Lapses in infection control were commonly identified at the affected facilities. These lapses all could potentially contribute to HCV transmission, although the exact means of transmission could not be identified.
While the increase in acute HCV infections might be due partly to improved screening and awareness of the potential for HCV infection in the hemodialysis setting, it still highlights the widespread potential for patients to acquire serious infections during dialysis care.
HCV transmission can be prevented when proper infection prevention and environmental disinfection practices are consistently followed.
Recommendations for Further Action
The CDC has further infection control recommendations for dialysis providers:
- Evaluate infection control practices in each facility and ensure adherence to infection control standards—The CDC offers a checklist and audit tools and safety guidelines for dialysis, injection safety, and hand hygiene.
- Ensure staff are aware of and trained to implement infection control guidelines—The CDC offers guidelines and training information for clinicians.
- Follow CDC recommendations for HCV screening of hemodialysis patients and management of patients who test positive—The CDC offers HCV FAQs.
- Immediately report any case of new HCV infection among patients undergoing hemodialysis to the state or local health department:
- New HCV infection can present as a change in anti-HCV status from negative to positive, in the absence of signs or symptoms.
- Communicate test results to the patient and arrange for clinical evaluation for possible treatment of HCV infection.
- Determine the HCV infection status of all other patients receiving care in the facility.
- Be transparent. Inform patients if HCV transmission is suspected to have occurred within the facility, and explain steps being taken to address the problem.
For more details on the recommendations, access the advisory.