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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

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