Prevention of Nosocomial Transmission of Hepatitis C Infection in a Hemodialysis Unit. A Prospective Study

Hepatitis C virus (HCV) infection in hemodialysis patients can be transmitted by transfusions and nosocomially. A high prevalence of HCV infection, over 50%, was demonstrated in our hemodialysis (HD) unit. In order to prevent the nosocomial spread of HCV infection in the HD unit a prospective study was begun separating anti-HCV positive patients from the negative ones. A total of 170 patients (83 anti-HCV positive) started this study in September 1994 and were followed for 4 years. A separate room and dedicated equipment were assigned to anti-HCV positive and anti-HCV negative patients. Of those 170 patients there were 15 hepatitis B virus (HBV) positive patients, 5 of whom were anti-HCV positive, who were treated in a separate room on dialysis equipment for anti-HCV positive or negative patients. Application of general precautions, as recommended by the Center for Disease Control and Prevention (CDC), was reinforced. During the first 12 weeks after implementing the precautions seven more anti-HCV positive patients were detected, and by December 1995 another two HCV infected patients were found. The follow-up included all changes in HD population treated until the end of 1998. The incidence of seroconversion to HCV was 12.9% in 1995, 7.1% in 1996, 5.0% in 1997, and 6.6% in 1998. The higher incidence of seroconversion in September to November 1994 was probably due to the nosocomial infection being in the incubation period at the time of isolation.

This prospective study in a large HD unit with a high prevalence of HCV infection demonstrates a relatively successful prevention of HCV spread. Procedure-related transmission of HCV in hemodialysis could be prevented by rigorous application of universal precautions as recommended by the CDC. As a second line of prevention, in highly burdened dialysis centers, segregation of HCV positive patients can help control nosocomial transmission.