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Hepatitis-2015 Orlando , USA July 20 - 22 2015

Hepatitis-2015 Orlando , USA July 20 - 22 2015. Garima Mittal. Dr. Garima Mittal (MBBS, MD) Associate Professor, Microbiology. Himalayan Institute of Medical Sciences, SRHU, Dehradun , Uttarakhand , India. Headings. Introduction Our dialysis unit Aims and objectives

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Hepatitis-2015 Orlando , USA July 20 - 22 2015

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  1. Hepatitis-2015Orlando, USAJuly 20 - 22 2015 Garima Mittal

  2. Dr. GarimaMittal (MBBS, MD) Associate Professor, Microbiology

  3. Himalayan Institute of Medical Sciences, SRHU, Dehradun, Uttarakhand, India

  4. Headings • Introduction • Our dialysis unit • Aims and objectives • Patients and methods • Results • Discussion • Conclusion and suggestions • References • Acknowledgement

  5. Introduction

  6. Our dialysis unit

  7. What we follow in our HD units

  8. Patients and methods

  9. Group 1 • Included 118 patients • 19 were HCV positive at the start of study • 99 were seronegative • Not following strict isolation program for HCV seropositive patients • Multidose heparin vials were used.

  10. Group 2 • Included 113 patients • 14 were HCV positive at the start of study • 99 were seronegative • Following strict isolation program for HCV seropositive patients by using dedicated areas, machines and dedicated health care workers • single dose heparin vials were used

  11. Exclusion criteria: Those who did not complete the period of study either due to death, leaving to other HD units or after kidney transplantation.

  12. Serological tests • Blood samples were collected from all patients and sera separated. • Tested for HCV antibodies using third generation ELISA kit (Hepanostika HCV ultra, Biomerieux, Netherlands, sensitivity:100%, specificity:99.8%). • Screening for anti-HCV antibodies was done at every three months to look for seroconversion.

  13. Statistical analysis • Data were analyzed using statistical package SPSS version 18 • Prevalence, odds ratios, P values and 95% confidence intervals (CI) were calculated to assess differences between studied groups. • Statistical significance was assessed at 0.05 probability level in all analysis.

  14. Isolation of HCV + and HCV- patients

  15. Dedicated area and machines for HCV+ patients

  16. Separate dialyzer re-processing units HCV + HCV -

  17. Stored tubings and dialyzer for reuse

  18. Results

  19. Gender-wise distribution of patients

  20. Gender-wise distribution of patients

  21. Underlying causes for chronic renal failure in both the groups • Chronic Glomerulonephritis (30.5%) • Diabetic Nephropathy (26.3%) • Hypertensive Nephropathy (19.5%) • Chronic interstitial Nephritis (11.3%) • Others (11.3%)

  22. Causes for chronic renal failure in both the groups

  23. HCV seroconversion in both groups

  24. Comparison of both groups

  25. Incidence of HCV with dialyzer reuse

  26. Discussion

  27. Comparison of different guidelines on HCV isolation

  28. Contd….. KDIGO: Kidney disease: Improving global outcomes

  29. Suggestions • Separate dialysis ward/room for HCV positive patients. • Whether or not to reuse dialyzers??? • Separate area for storage and reprocessing of HCV infected dialyzers • In new seroconversion : Increase the frequency of anti-HCV screening to monthly

  30. HCV RNA to be used as screening tool, if economically feasible. • Regular training of all health care staff, patients on HD and their attendants on infection control practices. • Long term follow up study on larger group of HD patients is required.

  31. Conclusions • In Haemodialysis units with a high prevalence of HCV seropositivity, strict isolation of HCV+ patients in combination with implementation of universal work precaution measures can limit the spread of HCV infection in HD patients.

  32. References 1. Agarwal SK. Hemodialysis of Patients with HCV Infection: Isolation Has a Definite Role. NephronClinPract 2011;117:c328–c332 2. Pol S, Vallet-Pichard A, Fontaine H, Lebray P. HCV infection and hemodialysis. SeminNephrol 2002; 22: 331–339. 3. Castell J, Gutiérrez G: Outbreak of 18 cases of hepatitis C in a hemodialysis unit (in Spanish). GacSanit 2005; 19: 214–220. 4. Spada E, Abbate I, Sicurezza E, Mariano A, Parla V, Rinnone S, Cuccia M, Capobianchi MR, Mele A: Molecular epidemiology of a hepatitis C virus outbreak in a hemodialysis unit in Italy. J Med Virol 2008; 80: 261–267. 5. Carneiro MA, Teles SA, Lampe E, Espírito, Santo MP, Gouveia-Oliveira R, Reis NR, Yoshida CF, Martins RM: Molecular and epidemiological study on nosocomial transmission of HCV in hemodialysis patients in Brazil. J Med Virol 2007; 79: 1325–1333. 6. Valtuille R, Fernández JL, Berridi J, MorettoH, del Pino N, Rendo P, Lef L: Evidence of hepatitis C virus passage across dialysis

  33. 7. Sartor C, Brunet P, Simon S, Tamalet C, Berland Y, Drancourt M: Transmission of hepatitis C virus between hemodialysis patients sharing the same machine. Infect Control Hosp Epidemiol 2004; 25: 609–611. 8. Harmankaya O, Cetin B, Obek A, Seber E: Low prevalence of hepatitis C virus infection in hemodialysis units: effect of isolation? Ren Fail 2002; 24: 639–644. 9. Barril G, Traver JA: Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures. Antiviral Res 2003; 60: 129– 134. 10. Yang CS, Chang HH, Chou CC, Peng SJ: Isolation effectively prevents the transmission of hepatitis C virus in the hemodialysis unit. J Formos Med Assoc 2003; 102: 79–85.

  34. Saxena AK, Panhotra BR, Sundaram DS, Naguib M, Venkateshappa CK, Uzzaman W, Mulhim KA: Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. Am J Infect Control 2003; 31: 26–33. • Gallego E, López A, Pérez J, Llamas F, Lorenzo I, López E, Illescas ML, Andrés E, Olivas E, Gómez-Roldan C: Effect of isolation measures on the incidence and prevalence of hepatitis C virus infection in hemodialysis. Nephron Clin Pract 2006; 104:c1–c6. • Shebeb AM, Kotkat AM, Abd El Reheim SM, Farghaly AG, Fetohy EM: An intervention study for prevention of HCV infection in some hemodialysis units in Alexandria. J Egypt Public Health Assoc 2006; 81: 119–141.

  35. 14. Alavian SM, Bagheri-Lankarani K, Mahdavi- Mazdeh M, Nourozi S: Hepatitis B and C in dialysis units in Iran: changing the epidemiology. HemodialInt 2008; 12: 378–382. 15. Agarwal SK, Dash SC, Gupta S, Pandey RM: Hepatitis C virus infection in haemodialysis: the ‘no-isolation’ policy should not be generalized. NephronClinPract 2009; 111:c133-c140. 16. Ross RS, Viazov S, Clauberg R, Wolters B, Fengler I, Eveld K, Scheidhauer R, Hüsing J, Philipp T, Kribben A, Roggendorf M: Lack of de novo hepatitis C virus infections and absence of nosocomial transmissions of GB virus C in a large cohort of German haemodialysispatients. J Viral Hepat 2009;16:230–238. 17. Mohamed WZ: Prevention of hepatitis C virus in hemodialysis patients: five years experience from a single center. Saudi J Kidney DisTranspl 2010; 21: 548–554.

  36. Acknowledgement • Dr Pratima Gupta: Professor & Head, AIIMS, Rishikesh • Dr R K Agarwal: Professor & Head, HIMS • Research committee, HIMS • Dr Shahbaz Ahmad: Nephrologist, HIMS • Dialysis staff and patients • Serology technicians

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