Challenges to Infection Control of Hep C, B and HIV

Challenges to Infection Control of Hep C, B and HIV Infection control and cross contamination prevention are imperative to ensuring high quality patient care and quality of life for all patients. In the hemodialysis clinics and hospital units where patients are in end stage renal disease the prevention of infection is of utmost concern as it is directly correlated to lowered morbidity and mortality rates. Blood borne pathogens and bacteria are transmitted through poor infection control practices and lack of cross contamination prevention procedures. To understand the importance of infection control and cross contamination prevention, it is first imperative to understand the risks and consequences of infection transmittal in the hemodialysis unit. The hemodialysis unit is unique in that the procedure allows pathogens to enter the body through access sites, injection sites, and catheterization, all of which increase risk of infection for already ill patients. The following explores the most common concerns in infection transmittal as H epatitis C and B, HIV, and common bacteria found in hemodialysis patients. This is followed by an exploration of methods in infection control, focusing on the procedures of cleaning, sterilization, and disinfection. An examination of staff education and training procedures that impact infection control and patient care follows. The research concludes with a summary and commentary. Research has often compared the incidences of HCV infections in hemodialysis and peritoneal dialysis in patients, finding that patients undergoing clinical bloodstream invasive hemodialysis procedures have three times higher rates of HCV infections (Horl et al 2004). This is reflective of nosocomial transmission of HCV within the clinical dialysis setting (Horl et al 2004). HCV is transmitted through cross-contamination, occurring through â€Å"blood, shared cannulas, and equipment, and blood transfusions† (Horl et al 2004 p 1390). A comparison of the outcome of hepatitis virus-positive and -negativ e kidney transplant and hemodialysis patients involved 384 kidney transplant patients (67 HBsAg positive, 39 anti-HCV positive, 278 hepatitis negative), transplanted between 1987 and 2001, and 403 hemodialysis patients (128 HBsAg positive, 83 anti-HCV positive, 192 hepatitis negative) who had started hemodialysis and were referred to the kidney transplant waiting list during the same period (Visnja et al 2008). Comparison of the groups’ survival rates, adjusted for patient age, showed that all kidney transplant patients survived longer than hemodialysis patients (p < 0.001) (Visnja et al 2008). Interestingly, HBV infection had a negative impact on patient survival, especially in hemodialysis patients, but HCV infection did not have a significant influence on patient survival (Visnja et al 2008). Thirty-two outpatient hemodialysis providers in the United States voluntarily reported 3699 adverse events to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) during 2006 (Klevens et al 2008). Among the 599 isolates reported, 461 (77%) represented access-associated blood stream infections in patients with central lines, and 138 (23%) were in patients with fistulas or grafts (Klevens et al 2008). The microorganisms most frequently identified were common skin contaminants (e.g., coagulase-negative staphylococci) (Klevens et al 2008). Hepatitis C (HCV) among maintenance hemodialysis patients has limited data on the incidence and prevalence. According to Bennett, Brachman and Jarvis (2007 p 360): â€Å"In 2002, 63% of dialysis centers tested patients for anti-HCV, and 11.5% reported having (symbol) 1 patient who became anti-HCV positive in 2002. The incidence rate in 2002 was 0.34% among centers that tested for anti-HCV, the prevalence of anti-HCV among patients was 7y.8%, a decrease of 25.7% since 1995. In the facilities that tested, the reported incidence was 0.34% and the prevalence3 was 7.8%. Only 11.5% of dialysis facilities reported newly acquired HCV infection among their patients†.