Table 5.

Steps to initiate concurrently and undertake following identification of a new HCV infection in a hemodialysis patient (adapted from CDC Health Alert²⁸)

A. Report the infection to appropriate public health authority. • Assess risk factors of the affected patient in conjunction with public health. B. Determine HCV infection status of all patients in the hemodialysis unit. • Test all patients treated in the center for HCV infection (Chapter 1) unless they are already known to have active infection. Follow-up and testing of patients who were treated in the center and those subsequently transferred or discharged may be warranted. C. Conduct a thorough root cause analysis of the infection and address infection control lapses. • Perform rigorous assessments of staff infection control practices to identify lapses. This should minimally include assessments of hand hygiene and glove change practices; injectable medication preparation, handling, and administration; and environmental cleaning and disinfection practices. • Share findings with all staff members and take action to address lapses. Staff education and retraining may be necessary. • Consider hiring a consultant with infection prevention expertise to provide recommendations for improvement of practices and work flow and/or to help implement actions to address identified lapses. • Conduct regular audits to ensure improved adherence to recommended practice. • Demonstrations of cleaning adequacy such as use of Glo Germ™ (Moab, UT) or luminol might be helpful for staff education. D. Communicate openly with patients. • Inform all patients of the reason for additional HCV testing and the results of their HCV tests. • If transmission within the center is suspected or confirmed, inform all patients of this. Patients should also be made aware of steps being taken to assess and improve practices.

CDC, Centers for Disease Control and Prevention; HCV, hepatitis C virus.