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Last Updated 5/12/13
   

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

Vital Signs: Evaluation of Hepatitis C Virus Infection Testing and Reporting — Eight U.S. Sites, 2005–2011 - Articles from the CDC's Morbidity and Mortality Weekly Report - May 10, 2013

Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9) - Free, full-text, Online First article from the Journal of the American Medical Association. - May 9, 2013

Study Suggests Only Half of Americans with Hepatitis C Receive Complete Testing for the Virus - Press release from the CDC. Article from HealthDay. - May 7, 2013

Aethlon Medical (AEMD) Note: An Update on the Clinical Status of the Aethlon Hemopurifier® in Hepatitis-C Care - May 7, 2013

New Bird Flu Poses "Serious Threat", Scientists Say - Articles from Reuters and the BBC. - May 1, 2013

Abstracts from Antimicrobial Agents and Chemotherapy - May 2013
Increased Peritoneal Dialysis Exit Site Infections Using Topical Antiseptic Polyhexamethylene Biguanide Compared to Mupirocin: Results of a Safety Interim Analysis of an Open-Label Prospective Randomized Study
Effectiveness of Disinfectants Used in Hemodialysis against both Candida orthopsilosis and C. parapsilosis Sensu Stricto Biofilms

Superbugs in LIvestock Becoming 'National Health Crisis' - Article from The Hill. - April 30, 2013

Multidrug-Resistant Organisms in Dialysis Patients - Early View Abstract from Seminars In Dialysis - April 29, 2013

New Guidelines Suggest HIV Screening for All Adults - Article from HealthDay. Clinical guidelines and editorial from Annals of Internal Medicine. - April 29, 2013

Germ-Zapping 'Robots': Hospitals Combat Superbugs - April 29, 2013

Hospitals See Surge of Superbug-Fighting Products - Article from AP.  - April 29, 2013

Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China - Free, full-text Online First article from The New England Journal of Medicine (NEJM). Related article on its spread to Taiwan from the BBC. - April 24, 2013

2-Page PDFs from the Centers for Disease Control and Prevention (CDC) - April 2013
Environmental Surface Disinfection in Dialysis Facilities: Notes for Clinical Managers
Checklist: Dialysis Station Routine Disinfection

WHO Says New Bird Strain Is "One of Most Lethal" Flu Viruses - Article from Reuters. - April 24, 2013

Experimental Drug for Hepatitis C Promising, Studies Show - Article from HealthDay.  - April 23, 2013
Free, Full-text, Online First articles from The New England Journal of Medicine
Sofosbuvir for Hepatitis C Genotype 2 or 3 in Patients without Treatment Options
Sofosbuvir for Previously Untreated Chronic Hepatitis C Infection

Persistent Nasal Methicillin-Resistant Staphylococcus Aureus Carriage in Hemodialysis Outpatients: a Predictor of Worse Outcome - Provisional abstract and full-text article (19-page pdf) from BMC Nephrology. - April 23, 2013

Antimicrobial Use and Stewardship Programs Among Dialysis Centers - Early View abstract from Seminars in Dialysis. - April 22, 2013

China Says Investigating Human to Human Spread of Bird Flu - Articles from Reuters and AP. - April 18, 2013

Identifying and Classifying Bloodstream Infections Among Hemodialysis Patients - Early View abstract from Seminars in Dialysis. - April 18, 2013

“Nightmare” Bacteria on the Rise in US Hospitals, Long-term Care Facilities - Free, full-text article from the Journal of the American Medical Association. - April 17, 2013

WHO Says No Poultry Contact in Some China Bird Flu Cases - Article from Reuters. - April 17, 2013

Gene Swapping Makes New China Bird Flu a Moving Target; Total Cases Rise to 60 - Articles from Reuters and the BBC. - April 15, 2013

 
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  HEMODIALYSIS VASCULAR ACCESS INFECTIONS

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

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
2011 Guidelines for the Prevention of Intravascular Catheter Related Infections - 83-page (pdf) from the Centers for Disease Control and Prevention (CDC)
Guideline for Prevention of Intravascular Device-related Infections - from the Centers for Disease Control and Prevention (CDC) - 2002

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

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

International Society for Peritoneal Dialysis  Treatment GuidelinesTraining Plans (pdf), and  QA Protocols
Adult Peritoneal Dialysis-related Peritonitis Treatment Recommendations: 2000 Update (pdf format) - from the International Society for Peritoneal Dialysis (ISPD) - (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)
infection control AND peritoneal dialysis - Pubmed search  Continually Updated!
infection control AND catheter AND peritoneal - Pubmed search  Continually Updated!
 

  ANTIBIOTIC-RESISTANCE

Antimicrobial Resistance Interagency Task Force - from the Centers for Disease Control and Prevention (CDC)
Multi-level Antimicrobial Susceptibility Testing Educational Resources from the CDC Division of Laboratory Systems (DLS)
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) - October 6, 2006
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
FDA Task Force on Antimicrobial Resistance - from the U.S. Department of Health and Human Services (HHS)
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
Sharps Safety and Needlestick Prevention from ECRI
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 - (pdf) article from the Morbidity and Mortality Weekly Report
(MMWR) - September 2005
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 - New 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

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
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
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 Season 2010-2011, Information for Healthcare Providers , Patient and Provider Education Materials from the Centers for Disease Control (CDC)
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 - guidance from the Center for Devices and Radiological Health (CDRH) - 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)
Hand Hygiene Resource Center web site
Healthcare-associated Infections (HAI) and 2011 National and State Healthcare-associated Infections Standardized Infection Ratio Report - from the Centers for Disease Control (CDC)

Healthcare Associated Infections - Web site by Kimberly-Clark. Patient's guide (2-page pdf) to hand hygiene.

Immunization Action Coalition (IAC) Publications: Needle Tips

Immunization Action Coalition (IAC) Publications: Vaccinate Adults

Infection Prevention Guide (pdf) and Checklist for Outpatient Care Settings (pdf) - from the Centers for Disease Control (CDC) - July 2011
Infectious Diseases Guidelines 2: What is new and how to use? video from the American Society of Transplantation - April 5, 2010
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
Immunization Registry Clearinghouse from the Centers for Disease Control (CDC)
List of Safety-Engineered Sharp Devices from the University of Virginia Health System web site

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
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
Hemodialysis Transducer Protectors - reported by RenalWEB
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 2009
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
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
Adult Peritoneal Dialysis-related Peritonitis Treatment Recommendations: 2000 Update (pdf format) - from the International Society for Peritoneal Dialysis (ISPD) - July 2000 (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) - 2000
Guideline for Environmental Infection Control in Health-Care Facilities, 2003 - (pdf) 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
Guidelines & Recommendations Prevention of Healthcare-Associated Infections - from the CDC
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
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
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 2012-2013 Season - 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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