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
The CDC reported no instances of H.I.V. being transmitted as a
result of Haemodialysis procedures (CDC 2001)
Therefore, the reviewer focused on the transmission of Hepatitis C,
as transmission is not uncommon, and considerable debate still
exists on the best mechanisms for prevention.
Three main issues emerged from the literature.
1) A number of authors consider haemodialysis machines to be a
potential source of infection. (Delarocque-Astagneau 2002,
Sartor et al 2004, Savey et al 2005). As a result, some authors
suggest that the CDC guidelines for Hepatitis C management in
insufficient.
Saxena et al (2003) isolated patients, staff and haemodialysis
machines (the normal protocol for Hep B management) in an
effort to reduce seroconversion rates.
Shamshiraz (2004) examined isolated versus non isolated
haemodialysis machines, with improved results for those on
isolated machines. However, a dichotomy exists within the
literature around this very point i.e isolation versus non-isolation.
Ireland’s recently published guidelines recommend the isolation
of machines for HBV, HCV and HIV (DoHC 2005), however some
contend that strict adherence to good infection control practice is
adequate (Jadoul et al 1998, Petrosillo et al 2001).
2) A number of factors are statistically significant or statistically
associated with Hepatitis C transmission in haemodialysis.
Holiday dialysis (where a patient receives a treatment, or a
number of treatments in a different dialysis unit) had a statistical
association with HCV seroconversion (Schneeberger et al 2000,
Carneiro et al 2005). The use of multi-dose drug vials has been
identified as a possible source of transmission in multiple
instances (Covic et al 1999, Krause et al 2003, Furusyo et al
2004).
Staff patient ratios and staff experience (Petrosillo et al 2000,
Saxena & Panhotra 2004) and the prevalence of HCV (Pujol et al
1996, Petrosillo et al 2000, Fissell et al 2004) have both been
identified as statistically significant.
The only factor repeatedly found to be an independent risk factor
for HCV is length of time on haemodialysis. It has been
suggested that even minor breaches in infection control,
multiplied over time, present the single largest risk to patients.
(Huang et al 1993, Sivapalasingam et al 2002, Hinrichsen et al
2002)
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