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Last Updated 06/18/17
   

Infection control is a responsibility of everyone involved with the dialysis treatment process. This resource page provides the latest information on infection control issues from the Centers for Disease Control and Prevention (CDC) as well as the dialysis-specific scientific journals.

Chronic hemodialysis patients are at high risk for infection because the process of hemodialysis requires vascular access for prolonged periods. In an environment where multiple patients receive dialysis concurrently, repeated opportunities exist for person-to-person transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, or hands of personnel. Furthermore, hemodialysis patients are immunosuppressed, which increases their susceptibility to infection, and they require frequent hospitalizations and surgery, which increases their opportunities for exposure to nosocomial infections. Bacterial infections, especially those involving vascular access, are the most frequent infectious complication of hemodialysis and a major cause of morbidity and mortality among hemodialysis patients.

Warning: Changes should never be made in a patient's treatment or care based solely on the information found here.  All patients have unique healthcare concerns and considerations and these 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 AND LATEST ARTICLES

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CMV and BKPyV Infections in Renal Transplant Recipients Receiving an mTOR Inhibitor–Based Regimen Versus a CNI-Based Regimen: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials - Articles in Press Abstract from Kidney International. - June 2017

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Amazing and Fantastic Infection Control: The Case of Dialyzer Reuse - related abstract - Free, Full-Text Article from American Journal Of Kidney Diseases. - June 2017

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Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost - Abstract from Nephron. - June 2017

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Trial of Transplantation of HCV-Infected Kidneys into Uninfected Recipients - Free, full-text, of Letter to the Editor from the New England Journal of Medicine. - June 15, 2017

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Elbasvir-Grazoprevir Effective Against HCV in Chronic Kidney Disease - (Registration required, but free.) Reuters Health article via Medscape Nephrology. - June 14, 2017

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Study Finds One in Five Hospitalized Adults Suffer Side Effects From Prescribed Antibiotics - Press release from Johns Hopkins Medicine. New Online abstract from JAMA Internal Medicine. - June 14, 2017

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HIV in the Dialysis Population: Current Issues and Future Directions - Early View Abstract from Seminars In Dialysis. - June 13, 2017

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ESRD Network Coordinating Council Webinar: Infection Prevention: Leadership, Interventions, Results, June 20, 2017, 3:00-4 PM EDT - Notice from Northwest Renal Network. Announcement (1-page pdf) and registration. - June 7, 2017

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HIV-Infected Living Kidney Donors Have Low ESRD Risk - Article from Renal & Urology News. - June 6, 2017

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Legionnaires' Hiding in Hospital, Nursing Home Plumbing Systems: CDC - Article from HealthDay. News brief from AHANews. Toolkit from the CDC. - June 6, 2017

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New Pediatric Protocol Reduces Missed Sepsis Diagnoses by 76 Percent - June 6, 2017

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Puerto Rico Declares Zika Outbreak over, CDC Maintains Travel Warning - June 6, 2017

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The Impact of Peritoneal Dialysis-Related Peritonitis on Mortality in Peritoneal Dialysis Patients - Free, Open Access article from BMC Nephrology. - June 5, 2017

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Ultra-Tough Antibiotic to Fight Superbugs - Article from the BBC. - May 2017

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New Combo Pill Offers Hope to Hepatitis C Patients Who Fail Other Treatment - May 31, 2017

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1 in 4 Nursing Home Residents Has Antibiotic-Resitant Bacteria - Article from HealthDay. - May 30, 2017

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New Drug Reduces Transplant and Mortality Rates Significantly in Patients with Hepatitis C - May 26, 2017

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Hepatitis C Drug Again Tops Part D Spend List at $7 Billion - Article from Healthcare Finance. - May 26, 2017

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Zika Virus Transmission—Region of the Americas, May 15, 2015–December 15, 2016 - Free, Full-Text Article from American Journal of Transplantation. - May 23, 2017

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Periodontitis and Early Mortality among Adults Treated with Hemodialysis: a Multinational Propensity-Matched Cohort Study - Free, Open Access Article from BMC Nephrology. - May 22, 2017

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CDC Issues Update on Emerging Multidrug Resistant Fungus - May 22, 2017

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Continuous Hemoadsorption with a Cytokine Adsorber during Sepsis - a Review of the Literature - Advance Online abstract from the International Journal of Artificial Organs. - May 22, 2017

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Doctors Have Resisted Guidelines to Treat Sepsis. New Study Suggests Those Guidelines Save Lives - Articles from STAT and HealthDay. Free, full-text, Online First articles from the New England Journal of Medicine. - May 21, 2017

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Ongoing Transmission of Candida auris in Health Care Facilities — United States, June 2016–May 2017 - Notes from the Field from the CDC's Morbidity and Mortality Weekly Report. - May 19, 2017

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Increased Resistance of Gram-Negative Urinary Pathogens after Kidney Transplantation - Free, Open Access Article from BMC Nephrology. - May 19, 2017

 
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  HEMODIALYSIS VASCULAR ACCESS INFECTIONS

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Dialysis Audit Tools: Includes pdfs for hemodialysis hand hygiene, catheter connect/disconnect, exit site care, and AV fistula/graft decannualation and Dialysis Checklists: Includes pdfs for catheter connect, catheter disconnect, exit site care, cannulation, and decannulation from the CDC's Safe Healthcare Blog about the Dialysis Bloodstream Infection (BSI web page) Prevention Collaborative

blue ball Guide to the Elimination of Infections in Hemodialysis - 78-page (pdf) document from the Association for Professionals in Infection Control and Epidemiology (APIC) web site
blue ball 2011 Guidelines for the Prevention of Intravascular Catheter Related Infections - 83-page (pdf) from the Centers for Disease Control and Prevention (CDC)
blue ball Guideline for Prevention of Intravascular Device-related Infections - from the Centers for Disease Control and Prevention (CDC) - 2002
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Patient Pocket Guide: 6 Tips to Prevent Dialysis Infections - Download file from the Centers for Disease Control and Prevention. - October 2013

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Reducing Bloodstream Infections in an Outpatient Hemodialysis Center — New Jersey, 2008–2011 - Article from the CDC's Morbidity and Mortality Weekly Report. - March 16, 2012

blue ball Vital Signs: Central Line--Associated Blood Stream Infections --- United States, 2001, 2008, and 2009 - Article from the CDC's Morbidity and Mortality Weekly Report. The article mentions the word "dialysis" 42 times. - March 2011
"The majority of central line--associated blood stream infections are now occurring outside of ICUs, many outside of hospitals altogether, especially in outpatient dialysis clinics."
K/DOQI™ Clinical Practice Guidelines for Vascular Access - Table of Contents
infection control AND hemodialysis - Pubmed search  Continually Updated!
infection control AND access AND hemodialysis - Pubmed search  Continually Updated!
 

  PERITONEAL CATHETER INFECTIONS

ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis–Related Infections (pdf format) - from the International Society for Peritoneal Dialysis (ISPD) 2011 - (pdf format requires Adobe Acrobat reader)
Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis - from the International Society for Peritoneal Dialysis (ISPD)
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ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment - Free, Open Access article from Peritoneal Dialysis International. - September/October, 2016

infection control AND peritoneal dialysis - Pubmed search  Continually Updated!
infection control AND catheter AND peritoneal - Pubmed search  Continually Updated!
 

  ANTIBIOTIC-RESISTANCE

Interagency Task Force on Antimicrobial Resistance (ITFAR) - from the Centers for Disease Control and Prevention (CDC)
Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006 release from the Centers for Disease Control and Prevention - 2006
MRSA in Healthcare Settings from the Centers for Disease Control (CDC)
Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Dialysis Patients --- United States, 2005 from Morbidity and Mortality Weekly Report - March 9, 2007
Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States - (pdf) article from the Centers for Disease Control and Prevention - October 16, 2007
Staphylococcus aureus Resistant to Vancomycin --- United States, 2002 - from the CDC Morbidity and Mortality Weekly Report (MMWR) - July 5, 2002

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship - Resource from the Agency for Healthcare Research and Quality. - September 2012

HHS Releases Action Plan to Combat Antimicrobial Resistance - press release from the U.S. Department of Health and Human Services - Click here for full pdf report.
Antimicrobial Resistance - from the Centers for Disease Control and Prevention (CDC)
Antibiotic (Drug) Resistance - from the National Institutes of Allergy and Infectious Diseases (NIAID)
Antibiotic Resistant Drug Information - from the FDA Center for Drug Evaluation and Research
Washington state's campaign to fight antibiotic resistance - from the Washington State Health Department
VRE (vancomycin-resistant enterococci) and dialysis - Pubmed search   Continually Updated!
MRSA (methicillin-resistant Staphylococcus aureus) and dialysis - Pubmed search   Continually Updated!
 

  NEEDLESTICK PREVENTION

Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program - from the Centers for Disease Control and Prevention (CDC) - 2004
Emergency Needlestick Information - from the Centers for Disease Control and Prevention (CDC) - 2008
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis - article from the Morbidity and Mortality Weekly Report (MMWR) - September 2013
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis - (pdf) article from the Centers for Disease Control and Prevention (CDC) - June 2001
Needlestick Prevention from OSHA
Occupational Exposure to Bloodborne Pathogens: Needlestick and Other Sharps Injuries, Final Rule from OSHA
Bloodborne Pathogens Standard; Extension of the Office of Management and Budget's (OMB) Approval of Information Collection (Paperwork) Requirements from the Occupational Safety & Health Administration (OSHA)
Sharp Safety:Understanding the Federal Needlestick Prevention Law, Part 1 - January 22, 2001 and Understanding the Federal Needlestick Prevention Law, Part 2 - (includes listing of states with their own OSHA plans) - February 8, 2001 from Nurses.com
needlestick injuries - Pubmed search   Continually Updated!
 

  HEPATITIS

Latest Scientific Journal Articles on Hepatitis

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

Hepatitis C Guideline Educational Tools - Resource from Kidney Disease: Improving Global Outcomes (KDIGO). - March 2011
Hepatitis A, B, and C: Learn the Differences (pdf format requires Adobe Acrobat reader) from the Immunization Action Coalition web site
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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 Guideline for Hepatitis C in CKD from Kidney Disease: Improving Global Outcomes (KDIGO) - August 2008
Revision to OSHA's Bloodborne Pathogens Standard and Frequently Asked Questions - April 2001
National Institute of Health Consensus Development Program: Management of Hepatitis C. 2002
Clinical Practice Guidelines for hepatitis (search result) from the  National Guideline Clearinghouse web site
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Free, Full-Text Articles from Annals Of Internal Medicine - July 1, 2014

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

CDC Recommended Practices for Infection Prevention in HD Facilities

An online continuing education training course, Infection Prevention in Dialysis Settings, that offers free CNE and CEU credits for dialysis nurses and technicians (see additional information at http://www.cdc.gov/dialysis/clinician/CE/infection-prevent-outpatient-hemo.html). Launched June 2012.

CDC’s Core Interventions for Dialysis Bloodstream Infection Prevention - In an effort to decrease rates of bloodstream infections among hemodialysis patients, the CDC Dialysis Bloodstream Infection Prevention Collaborative has developed this set of interventions that participating facilities have implemented.

Dialysis Bloodstream Infection Prevention Audit Tools - Facilities can use the audit tools to assess how well their staff is adhering to CDC-recommended practices. Audit tool results should be regularly reviewed with staff to help promote desired practices and inform quality improvement projects.

Dialysis Bloodstream Infection Prevention Checklist Tools - Facilities can implement the checklist tools during orientation or training of newly hired staff. They may also be used as a resource during infection prevention education or as a posted reminder of recommended practices.

Dialysis Bloodstream Infection Prevention Protocols - Facilities can use the protocols to promote CDC-recommended practices for infection prevention in hemodialysis facilities.

CDC’s Dialysis Safety Website: www.cdc.gov/dialysis

  WEB RESOURCES

Latest Scientific Journal Articles on Dialysis and Transplant Infections

AHRQ Toolkit - Resource from the Agency for Healthcare Research and Quality. The ESRD Toolkit was created to help end-stage renal disease clinics prevent healthcare-associated infections in dialysis patients.  - January 2015

AIDS Info from the U.S. Department of Health and Human Services
Biofilms: Microbial Life on Surfaces from the CDC journal Emerging Infectious Diseases
CDC has an extensive list of resources for bioterrorism
Compliance Control from HyGenius: The Importance of Hand-Washing - web page
Flu (Influenza) Health Topic from the National Institute of Allergy and Infectious Diseases (NIAID)
Good Health Habits for Preventing the Flu from the Centers for Disease Control and Prevention (CDC) - October 6, 2006
Guidance for Industry and FDA Staff - Medical Glove Guidance Manual - (pdf) guidance from the FDA Medical Devices Section - January 22, 2008
Guidance for Industry: Assessing Donor Suitability and Blood and Blood Product Safety in Cases of Known or Suspected West Nile Virus Infection from the FDA Center for Biologics Evaluation and Research (CBER)
Hand Hygiene - Video from The New England Journal of Medicine. - March 2011
Hand Hygiene in Healthcare Settings from the Centers for Disease Control (CDC)
Healthcare-associated Infections (HAI) and 2011 National and State Healthcare-associated Infections Standardized Infection Ratio Report - from the Centers for Disease Control (CDC)

Immunization Action Coalition (IAC) Publications: Needle Tips

Immunization Action Coalition (IAC) Publications: Vaccinate Adults

Infection Prevention Guide and Checklist for Outpatient Care Settings - from the Centers for Disease Control (CDC) - July 2011
Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials - from the CDC's Morbidity and Mortality Weekly Report via JAMA - November 5, 2008
blue ball Information for Healthcare Providers and Patient and Provider Education Materials from the Centers for Disease Control (CDC)
Immunization Information Systems from the Centers for Disease Control (CDC)

OSHA web site information on bloodborne pathogens

Pandemic Flu

Protect Yourself Poster - poster on bloodborne exposures to pathogens from the CDC web site - January 2008
2008 Quick Reference Chart on Immunization for Providers - (pdf) from the Centers for Medicare & Medicaid Services web site
Sepsis Alliance web site
Severe Acute Respiratory Syndrome (SARS) from the World Health Organization (WHO)

Tuberculosis from the OSHA web site

Use of Anthrax Vaccine in Response to Terrorism: Supplemental Recommendations of the Advisory Committee on Immunization Practices from the CDC Morbidity and Mortality Weekly Report (MMWR) - November 15, 2002
West Nile Virus (WNV) Infection: Information for Clinicians and West Nile Virus Basics from the Centers for Disease Control (CDC)
Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) web site
Infection Control Today web site
Infectious Diseases Society of America (IDSA) web site
The International Health Care Worker Safety Center's Exposure Prevention Information Network (EPINet) web site
International Society for Peritoneal Dialysis (ISPD) web site
National Institute of Allergy and Infectious Diseases (NIAID) web site
U.S. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) web site
U.S. National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention (NIOSH/CDC) web site
 
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  ESSENTIALS AND CLASSICS

Influenza information and guidelines from the CDC
Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus - information from the National Institutue for Occupational Safetyand Health - March 2008 
Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease (pdf) from the Centers for Disease Control and Prevention (CDC) - December 2012
Sterilants and High Level Disinfectants Cleared by FDA in a 510(k) with General Claims for Processing Reusable Medical Devices from the FDA's Medical Devices - March 2015
Occupational Safety and Health Administration (OSHA) Regulations for Bloodborne Pathogens (1910.1030). Here is a list of fact sheets.
 
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  CLINICAL GUIDELINES AND RECOMMENDATIONS

Compendium of strategies to prevent and treat staph and C difficile infections, ventilator-associated pneumonia, bloodstream infections caused by central-line catheters, and urinary tract and surgical site infections - from Infection Control & Hospital Epidemiology - October 8, 2008
Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis - (pdf) from the International Society for Peritoneal Dialysis (ISPD) - 2000
Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials - from MMWR/Centers for Disease Control and Prevention (CDC) - August 15, 2008
2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections - from the Centers for Disease Control and Prevention (CDC)
Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities - from the Centers for Disease Control and Prevention (CDC) - 2010
Recommendations for Using Antiviral Agents for Influenza - from the Centers for Disease Control and Prevention (CDC)
Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 - from the Centers for Disease Control and Prevention (CDC) - 2004
ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis–Related Infections - from the International Society for Peritoneal Dialysis (ISPD) - 2011
Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis - (pdf) from the International Society for Peritoneal Dialysis (ISPD) - 2000
CDC’s Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus - from the Centers for Disease Control and Prevention (CDC)
Guideline for Hand Hygiene in Healthcare Settings - 2002 - from the Centers for Disease Control and Prevention (CDC)
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 - from the Centers for Disease Control and Prevention (CDC) - June 2007
Guideline for Prevention of Intravascular Device-related Infections - from the Centers for Disease Control and Prevention (CDC) - 2002
Guidelines for the Management of Intravascular Catheter Related Infections - from the Morbidity and Mortality Weekly Report (MMWR) - August 2002
Materials to Promote Hand Hygiene in your Healthcare Facility - from the Centers for Disease Control and Prevention (CDC)
Data and Statistics for Dialysis-associated Outcomes - from The Centers for Disease Control and Prevention (CDC)
Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients - April 2001; from the CDC Morbidity and Mortality Weekly Report (MMWR).  
Revised Preventive Measures to Reduce the Possible Risk of Transmission of Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) by Blood and Blood Products - guidance document from U.S. Department of Health and Human Services Food and Drug Administration (FDA) on "Mad Cow Disease"
Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection - June 2000 - from the CDC Morbidity and Mortality Weekly Report (MMWR).
Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 - from the Centers for Disease Control and Prevention (CDC) - December 2005
Guideline for Disinfection and Sterilization in Healthcare Facilities - (pdf) from the Centers for Disease Control and Prevention (CDC) - 2008
blue ball U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis (Click here for the pdf format version) - from the Centers for Disease Control and Prevention (CDC) - 2001
Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus - (7-page pdf) from the Centers for Disease Control and Prevention (CDC) - 2016
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis - from the Morbidity and Mortality Weekly Report (MMWR) - 2005
Vaccine recommendations for patients on chronic dialysis - The Advisory Committee on Immunization Practices and the American Academy of Pediatrics - abstract from Seminars in Dialysis - March 2000
Vaccine recommendations and/or guidelines from the Center for Disease Control (CDC)
  * Recommended Adult Immunization Schedule: United States, 2013 - Recommendations of the Advisory Committee on Immunization Practices (ACIP) - February 2013
  * Influenza Vaccination - from the Centers for Disease Control and Prevention (CDC)
  * Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008 - July 17, 2008
  * Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP) - May 2005
  * Recommended Adult Immunization Schedule for the United States, 2012  - February 2012
  * Use of Anthrax Vaccine in Response to Terrorism: Supplemental Recommendations of the Advisory Committee on Immunization Practices - November 15, 2002
  * Influenza Vaccination of Health-Care Personnel - Recommendations of the Advisory Committee on Immunization Practices (ACIP) - February 2006
  * Use of Standing Orders Programs to Increase Adult Vaccination Rates - Recommendations of the Advisory Committee on Immunization Practices (ACIP) - March 2000
 
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  DISCUSSION FORUM

Vascular Access Issues on RenalWEB
General Nursing Discussion Forum - RenalWEB Discussion Forum
 
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  STATISTICS

National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 (pdf format requires Adobe Acrobat reader) - from The Centers for Disease Control and Prevention (CDC)
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%) - from The Centers for Disease Control and Prevention (CDC)
 
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  UPCOMING EVENTS

National Institute of Allergy and Infectious Diseases (NIAID) Selected Events - NIAID web site
FDA/Center for Drug Evaluation and Research (CDER) Sponsored Workshops and Meetings and Presentations
Centers for Disease Control and Prevention Conferences and Events
 
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  RELATED TOPICS

Guidelines & Recommendations for Immunizations - infection control practices from the Centers for Disease Control and Prevention (CDC)
AIDS (auto immune deficiency syndrome) and dialysis - PubMed search - Continually Updated!
hepatitis AND dialysis - PubMed search - Continually Updated!
hepatitis B - PubMed search - Continually Updated!
hepatitis C - PubMed search - Continually Updated!
hepatitis AND vaccine - PubMed search - Continually Updated!
 
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  INPUT / SUGGESTIONS

E-mail to RenalWEB on the Hepatitis Topic
 
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