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Dossantos,
J.P.; Loureiro, A.; Neto, M.C.; Peteira, B.J.G.
"Impact of Dialysis Room and Reuse Strategies on
the Incidence of Hepatitis C Virus Infection in
Haemodialysis Units." Nephrology Dialysis
Transplantation, October 1996; 11 (10):2017-2022.
According
to the authors' abstract of an article published in
Nephrology Dialysis Transplantation, "Background:
Despite the advent of screening of blood products for
anti-hepatitis C virus (Hepatitis C Virus), the incidence of Hepatitis C Virus
infection among haemodialysis (HD) patients is
alarmingly high and suggests transmission within the
HD unit. To analyze trends in the prevalence and
incidence of Hepatitis C Virus infection, and evaluate the impact of
dialysis room and reuse policies on the incidence of
Hepatitis C Virus infection, a hospital survey instrument was sent
out to medical directors of all 71 HD units in
Portugal in August 1994. Information for the years
1991, 1992 and 1993 was requested with respect to Hepatitis C Virus
infection, defined as positive anti-Hepatitis C Virus test.
Sixty-two of 71 units (87%) treating 4232 patients in
1993 responded. Overall, data from 5774 patient-years
were available for analyses. Observations over
multiple intervals were pooled into a single sample,
and pooled logistic regression was used to evaluate
the relationship between risk factors/strategies and
incidence of Hepatitis C Virus infection. By 1993, regular anti-Hepatitis C Virus
testing of patients and staff was practised by 98% and
82% of units, respectively. There was a significant
decline in the incidence of Hepatitis C Virus infection from 9.9% in
1991 to 5.7% in 1992 and 5.1% in 1993. 'The incidence
was directly related to the prevalence in the dialysis
unit. Units with a prevalence of less than 19% had an
annual incidence of 2.5% compared to a 35.3% incidence
in units with a prevalence greater than 60%. There was
a wide variation in the incidence of Hepatitis C Virus infection in
HD units across the country, with geographical
location, unit ownership and socioeconomic factors
playing a significant role. The incidence was lowest
among units that: (i) were located in the northern
regions of the country; (ii) were private
hospital-based units: and (iii) used dedicated
machines or separate rooms for anti-Hepatitis C Virus-positive
patients. The incidence among units that reprocessed
dialysers (6.1%) was not significantly different from
that among units that did not reprocess dialysers
(7.4%). However, among units that did reprocess
dialysers, the incidence of Hepatitis C Virus infection was lowest
in: (i) units that used separate rooms for
reprocessing dialysers from anti-Hepatitis C Virus-positive patients
or did not reprocess these dialysers; and (ii) units
that used Renalin as the sterilant. These results
suggest the transmission of Hepatitis C Virus infection in HD units
and that use of dedicated machines and isolation of
anti-Hepatitis C Virus-positive patients and their dialysers may
reduce the incidence of Hepatitis C Virus infection." The
corresponding author for this study is: BJG Pereira,
Tuffs Univ New England Med Ctr, Div Nephrol, Box 391,
750 Washington St, Boston, MA 02111 USA. For
subscription information for this journal contact the
publisher. Oxford Univ Press United Kingdom, Walton
St, Journals Dept, Oxford, England OX2 6DP.
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