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).
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
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.
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.