Table 3.
Prevalence of Hemodialysis-Associated Hepatitis C Virus (HCV) Infection among Patients by the Observed Patient-Care Practices in Their Study Treatment Facilities with Recommended Practices Given for Reference.
| Patient-Care Practices | Patients At Risk For Hemodialysis-Associated HCV Infection* | ||||
|---|---|---|---|---|---|
| Recommended† | Observed in Study Facility | No. (%) of Total Patients | No. (%) | % HCV Positive‡ | Unadjusted Odds Ratio (95% Confidence Interval)‡ |
| Avoid sharing equipment and supplies between patients. Items taken into the dialysis station should be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before taken to a clean area or used on another patient. Do not carry medication vials, syringes, alcohol swabs, or supplies in pockets. |
Items reused for multiple patients without cleaning and disinfection (e.g., fistula clamps) | ||||
| Yes | 329 (11.2) | 216 (10.5) | 3.8 | 1.3 (0.3–5.0) | |
| No | 2604 (88.8) | 1840 (89.5) | 3.0 | 1.0 | |
| Unused clean supplies at dialysis station not discarded between patients (e.g., vacutainers) | |||||
| Yes | 374 (12.8) | 276 (13.4) | 3.6 | 1.2 (0.4–3.5) | |
| No | 2559 (87.3) | 1780 (86.6) | 3.0 | 1.0 | |
| Supplies carried in staff pockets (e.g., rolls of adhesive tape) | |||||
| Yes | 2163 (74.7) | 1528 (75.2) | 3.9 | 2.4 (0.9–6.4) ¶ | |
| No | 734 (25.3) | 505 (24.8) | 1.6 | 1.0 | |
| Medication preparation and distribution. When multiple dose medication vials are used, prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not use common medication carts to deliver medications to patients. |
Medications prepared in centralized area outside treatment area | ||||
| Yes | 1544 (53.9) | 1137 (56.8) | 2.7 | 1.0 | |
| No | 1323 (46.2) | 866 (43.2) | 3.8 | 1.5 (0.7–2.9) | |
| Mobile medication cart used to distribute injectable medications in treatment area | |||||
| Yes | 1373 (46.8) | 943 (45.9) | 3.9 | 1.6 (0.8–3.2) ¶ | |
| No | 1560 (53.2) | 1113 (54.1) | 2.5 | 1.0 | |
| Disinfection of patient care station. Clean and disinfect the dialysis station between patients. Give special attention to cleaning control panels on the dialysis machines. Discard all fluid and clean and disinfect all surfaces and containers associated with the prime waste. |
Frequency dialysis machine monitor knobs decontaminated between patients | ||||
| ≤70% of time | 688 (23.5) | 467 (22.7) | 5.3 | 2.1 (1.2–4.0)§ | |
| >70% of time | 2245 (76.5) | 1589 (77.3) | 2.6 | 1.0 | |
| Priming receptacle reused between patients without decontamination | |||||
| Yes | 1254 (42.8) | 860 (41.8) | 4.8 | 2.8 (1.4–5.6)§ | |
| No | 1679 (57.3) | 1196 (58.2) | 1.8 | 1.0 | |
| Separation of clean and dirty areas. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or adjacent area to where used equipment or blood samples are handled. |
Blood specimens handled in same area or adjacent to medications and clean supplies | ||||
| Yes, when medications were being prepared or other clean supplies were present | 313 (10.7) | 192 (9.3) | 6.3 | 2.4 (1.02–5.7)§ | |
| Yes, although no clean items were present at the same time | 237 (8.1) | 167 (8.1) | 4.7 | 1.7 (0.8–3.9)¶ | |
| No | 2018 (68.8) | 1448 (70.4) | 2.7 | 1.0 | |
| Hand washing and glove changing. Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station; remove gloves and wash hands between each patient or station |
Frequency of hand washing only** | ||||
| <33% | 2215 (75.5) | 1595 (77.6) | 3.3 | 1.4 (0.5–3.5) | |
| ≥33% | 718 (24.5) | 461 (22.4) | 2.5 | 1.0 | |
| Frequency of glove changing only** | |||||
| <41% | 2085 (71.1) | 1454 (70.7) | 3.2 | 1.1 (0.4–2.7) | |
| ≥41% | 848 (28.9) | 602 (29.3) | 3.0 | 1.0 | |
| Frequency of hand washing and glove changing** | |||||
| <17% | 2103 (71.7) | 1493 (72.6) | 3.4 | 1.5 (0.6–4.0) | |
| ≥17% | 830 (28.3) | 563 (27.4) | 2.3 | 1.0 | |
*
Defined as patients who had spent ≥80% of their hemodialysis career at the study facility, were not known to be HCV-positive at the time of admission to the study facility, attended a study facility with at least one HCV-positive patient, and reported no history of injection drug use.
†
See reference14.
‡
Univariate analysis adjusted for complex sampling design.
§
P<0.05
¶
P≥0.05<0.25
**
Between patient care stations, between a patient care station and a clean area (e.g., nurse’s station), and between a contaminated area (e.g., where blood specimens or used items were handled) and a patient care station.