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Last Updated 04/13/08

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Hepatitis has been a long-standing problem in hemodialysis facilities. Essentially, hepatitis is an inflammation of the liver caused by a virus. Hepatitis viruses are bloodborne pathogens and are major biological hazards for everyone in the dialysis facility.  Hepatitis viruses, unlike HIV, can survive for long periods of time outside the human body.  

Hepatitis causes varying degrees of liver damage. There are several different types of hepatitis viruses, among them A, B, C, D, E and G. Previously, hepatitis B was a major problem in dialysis facilities, but the combination of infection control precautions and the development of a vaccine has greatly reduced its incidence. 

The Centers for Disease Control reported in the National Surveillance of Dialysis-Associated Diseases in the U.S., 2002 (requires Adobe Acrobat reader) that in 2002, routine testing for antibody to hepatitis C virus (anti-HCV) was performed on
patients at 64% of centers; anti-HCV was found in 7.8% of patients.. There is a growing concern that hepatitis C will become a serious worldwide healthcare problem in the next decade. See the Fact Sheet on Hepatitis C from the Centers for Disease Control..

Occupational Safety and Health Administration (OSHA) regulations regarding bloodborne pathogens are applicable in US dialysis facilities. Infection control procedures, universal precautions, and chemical disinfectant and sterilants are used in all dialysis facilities to reduce the risk to both staff and patients of hepatitis transmission. Hepatitis viruses are easily destroyed by a diluted bleach solution (0.5% sodium hypochlorite), which is widely used in dialysis centers to disinfect table tops, chairs, and dialysis machine knobs and dials. Disinfectants and sterilants are used to clean the internal fluid pathways of the dialysis machine and are used for dialyzer reprocessing (reuse). The OSHA web site provides an index for bloodborne pathogens regulations and information.

The most common cause of hepatitis transmission to staff members is needlestick injuries. Federal needle safety legislation became effective on April 18, 2001 and the new requirements will be enforced on July 17, 2001.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.

  NEWS & LATEST INFORMATION
Guidelines for Hepatitis C in Chronic Kidney Disease Issued - CME program through MedScape - April 8, 2008 (free registration required)
NKF: HCV Outbreaks at Dialysis Units Linked to Outmoded Infection Control - article from MedPage Today - April 7, 2008
A new adjuvant improves the immune response to hepatitis B vaccine in hemodialysis patients - abstract from Kidney International - April 2008
Sharp Rise in U.S. Hepatitis C-Related Deaths - article from HealthDay - March 27, 2008
Scripps Florida scientists develop a process to disrupt hepatitis C virion production - article from Scripps Research Institute/EurekAlert! - March 20, 2008
Resources for Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus - information from the National Institutue for Occupational Safetyand Health - March 2008
Latest Hepatitis News Stories - Excite News Search Continually Updated!
Latest Hepatitis News Stories - Yahoo! News Continually Updated!
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  WEB RESOURCES
Latest Scientific Journal Articles on Hepatitis - list compiled by RenalWEB's Journal Watch
Hepatitis C Coordinator Web site - from the Centers for Disease Control and Prevention (CDC) web site

Viral Hepatitis web pages from the Centers for Disease Control (CDC) web site

Viral Hepatitis Serology: Hepatitis A - E educational materials from the Centers for Disease Control (CDC) web site
Hepatitis Surveillance Report No. 59 (pdf format requires Adobe Acrobat reader) from the CDC web site - September 2004
Hepatitis C: Incidence, Prevalence, Current Therapies and Implications for Nephrology (CD-ROM) (page down for link) from the ANNA web site
Hepatitis C virus infection in dialysis patients full-text scholary review from Hemodialysis International - July 2007
Hepatitis A, B, and C: Learn the Differences (pdf format requires Adobe Acrobat reader) from the Immunization Action Coalition web site
Current Issues with Hepatitis B Vaccine from the Institute for Vaccine Safety of John Hopkins University.

OSHA web site information on bloodborne pathogens
Protect Yourself Poster - poster on bloodborne exposures to pathogens from the CDC web site - January 2008
Guidance for Industry and FDA Staff - Medical Glove Guidance Manual - guidance from the Center for Devices and Radiological Health (CDRH) - January 22, 2008
Issues in Healthcare Settings: Infectious Diseases from the CDC web site
List of Safety-Engineered Sharp Devices from the University of Virginia Health System web site
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  ESSENTIALS AND CLASSICS

Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients from the CDC Morbidity and Mortality Weekly Report (MMWR) - April 27, 2001
National Surveillance of Dialysis-Associated Diseases in the U.S., 2002 - 10 page report from the CDC. (It is in pdf format which requires Adobe Acrobat reader.)
Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease from the CDC Morbidity and Mortality Weekly Report (MMWR) - Oct. 16, 1998
General Infection Control Recommendations for the dialysis center from the CDC Hospital Infections Program.
Occupational Safety and Health Administration (OSHA) Regulations for Bloodborne Pathogens (1910.1030). Here is a summary of the key provisions.
Universal Precautions from the National Institute of Health
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  ORGANIZATIONS
The American Association for the Study of Liver Diseases
American Liver Foundation
Centers for Disease Control and Prevention (CDC)
Hepatitis Foundation International
Infectious Diseases Society of America (IDSA)
National Foundation for Infectious Diseases
National Institute of Allergy and Infectious Diseases (NIAID)
Occupational Safety and Health Administration (OSHA)
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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
MEDLINE PLUS for hepatitis Continually Updated!
hepatitis AND dialysis Continually Updated!
infection control AND hepatitis AND dialysis Continually Updated!
hepatitis B Continually Updated!
hepatitis C Continually Updated!
hepatitis AND vaccine Continually Updated!
needlestick injuries Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  WEB SEARCH ENGINES
Hepatitis web sites by Yahoo! Continually Updated!
Hepatitis web sites by AOL Continually Updated!
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  CLINICAL GUIDELINES

Guidelines for the Management of Occupational Exposures to Hepatitis B, Hepatitis C, and HIV and Recommendations for Postexposure Prophylaxis. The MMWR report also includes:

  • Appendix A: Practice Recommendations for Health-Care Facilities Implementing the U.S. Public Health Service Guidelines for Management of Occupational Exposures to Bloodborne Pathogens.
  • Appendix B: Management of Occupational Blood Exposures.
  • Appendix C: Basic and Expanded HIV Postexposure Prophylaxis Regime

Viral Hepatitis Recommendations and Guidelines from the Centers for Disease Control and Prevention (CDC):

KDIGO Guidelines for Hepatitis C in Chronic Kidney Disease Issued - CME program through MedScape - April 8, 2008 (free registration required)
Infection control practices from the Centers for Disease Control and Prevention (CDC) - "At-A-Glance Guide" (pdf format requires Adobe Acrobat reader) - May 2001
Revision to OSHA's Bloodborne Pathogens Standard and Frequently Asked Questions - April 2001
7 Guidelines for Prevention of Healthcare-Associated Infections from the CDC
Chronic Hepatitis C: Current Disease Management from the NIDDK (November 1999)
Recommended Adult Immunization Schedule: United States, October 2007–September 2008 from the Annals of Internal Medicine - November 20, 2007
National Institute of Health Consensus Development Program: Management of Hepatitis C. March 24-26, 1997
Clinical Practice Guidelines for hepatitis (search result) from the  National Guideline Clearinghouse web site
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 NEEDLESTICK INJURIES
Who can you talk to if you've been stuck? The National Clinicians' Post-Exposure Prophylaxis Hotline (PEPLine) offers treating clinicians up-to-the-minute advice on managing occupational exposures to HIV, hepatitis and other bloodborne pathogens.
OSHA web site information on needlestick Prevention
Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program - from the Centers for Disease Control and Prevention web site
See the California Legislation that went into effect on July 1, 1999 - Sharps Injury Amendments to Title 8 Section 5193, Bloodborne Pathogens. View the final proposal that was adopted. Many dialysis centers are not complying with the legislation, citing a variety of reasons.
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  DISCUSSION FORUM
General Dialysis Nursing Issues and Questions (No dedicated RenalWEB forum)
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  PRODUCTS
Medisystems MasterGuard™ Safety Needles
Minntech Renal Systems Renalin™ Sterilant
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  STATISTICS
Hepatitis C Virus (HCV) infection is the most common chronic bloodborne infection in the United States. Approximately 3.9 million (1.8%) persons in the United States are infected with HCV. About 7% of these may have acquired their infection from blood transfusion. Source: CDC Fact Sheet on Hepatitis C.
After needle stick or sharps exposure to HCV positive blood, about 2 (1.8%) healthcare workers out of 100 will get infected with HCV (range 0%-10%). Source: CDC
Of the estimated 3.9 million (1.8%) Americans have been infected with HCV, 2.7 million are chronically infected. Source: CDC
For hepatitis C, chronic infection will occur in 75-85% of infected persons, chronic liver disease in 70% of infected persons. Source CDC
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  UPCOMING EVENTS
 
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  RELATED TOPICS
Successful Infection Control - topic page from RenalWEB
AIDS (auto immune deficiency syndrome) and dialysis - PubMed search
VRE (vancomycin-resistant enterococci) and dialysis - PubMed search
MRSA (methicillin-resistant Staphylococcus aureus) and dialysis - PubMed search
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  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Hepatitis Topic
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