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HBV Infection Prevention During Hemodialysis Outside the Dedicated Renal Unit: Issues and Implications in the Acute Care Setting

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      Background

      Hemodialysis (HD) patients are at increased risk for contracting hepatitis B (HBV). Special precautions, including patient, staff and equipment segregation, are observed while HBV positive patients undergo dialysis, because standard precautions alone are insufficient to protect patients and staff from HBV exposure during dialysis. Renal staff are familiar with HBV dialysis precautions; however non-renal healthcare teams may not be aware of the need for precautions during dialysis treatments, including continuous renal replacement therapy (CRRT).

      Methods

      Existing policies were reviewed and an extensive literature review was performed, including an attempt to identify guidance for HBV dialysis precautions during CRRT. The Inpatient Renal and Infection Prevention & Control teams collaborated on developing policy to address HBV positive patients receiving CRRT or intermittent HD in settings other than a dedicated renal unit and strategies for educating non-renal healthcare personnel.

      Results

      No institutional policies addressed HBV dialysis precautions for the CRRT population, and no guidance for HBV infection prevention during CRRT was identified in the literature. A new Clinical Practice Policy was developed to ensure compliance with national regulations in all locations and modalities of renal replacement therapy, including CRRT. House-wide standards and education for HBV dialysis isolation were developed and implemented for non-renal staff. Barriers identified and addressed included how to identify patients requiring HBV dialysis precautions (including HBV serology testing and HBV vaccination workflows), how to apply infection prevention precautions for HBV positive patients receiving CRRT, and how to communicate need for HBV dialysis precautions outside of the renal unit to non-renal healthcare personnel.

      Conclusions

      HBV dialysis precautions may be inconsistently applied to inpatient settings other than the renal unit, particularly to patients receiving CRRT. Policy development and educational efforts are required to ensure measures to prevent HBV transmission are extended to all hospitalized patients undergoing intermittent HD or CRRT.
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