Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
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A review of Blood Borne Virus transmission in Haemodialysis
Units internationally.
Brendan Reddy RN (Adult) Diploma in Higher Education, ENB 136
(Renal Nursing). BSc (Hons),MSc Candidate at the Department of
Nursing and Health Science, Athlone Institute of Technology.
Dialysis Unit
Midland Regional Hospital
Tullamore
Co. Offaly
Tel: 05793-58733
Email: brendan.reddy@mailq.hse.ie
Background:
Haemodialysis is a therapeutic intervention used to compensate for
renal failure. It involves pumping a patient’s blood through a filter
containing a semi-permeable membrane, in order to remove
metabolic waste, maintain physiological electrolyte levels and
remove excess fluid. Without this treatment such patients would die
from an accumulation of waste products such as urea and
creatinine, fluid overload and electrolyte imbalance.
The process is typically carried out for four hours three times a
week. In order to be effective, the blood must be pumped at high
speeds, typically 300ml/min or greater.
To achieve such pump speeds, good vascular access is required. A
large bore catheter, is inserted into a large vein, usually the internal
jugular, or an arteriovenous fistula is surgically fashioned into which
needles are inserted each treatment (Levy 2001).
A number of patients will receive such treatment at the same time
in a typical dialysis unit.
The connecting and disconnecting of patients to machines, the
responding of staff to alarms and manipulation of vascular access
during treatments because of poor blood flows all give rise to
potential contact with large volumes of blood, and in the absence of
rigorous infection control, can allow for the transmission of
infections between patients. As a result, patients receiving dialysis
treatment are at an increased risk of contracting a Blood Borne
Virus (BBV).
The Centre for Disease Control (CDC) in Atlanta USA, recognised
this risk in the 1970’s, and issued very specific guidelines on the
management of BBV’s in haemodialysis settings. Since that time the
CDC has set the bench mark for best practice in this area, and the
most recent CDC guidelines (CDC 2001) are referenced in many
local guidelines, (Department of Health 2002, Department of Human
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