Page 118 - policy and procedure infection control

Policies and Procedures on Infection Control

ADDITIONAL GUIDELINES ADAPTED FROM THE DOQI and CDC
MANAGEMENT OF THE INFECTIVE PATIENT (HBV, HCV, HIV)
Due to the nature of haemodialysis treatment and the likelihood of receiving multiple blood
transfusions, long term haemodialysis patients have a higher risk of acquiring Hepatitis B virus
(HBV) and Hepatitis C virus (HCV) infections compared to the normal population.
Once infected these patients are more likely to become chronic carriers. Hence, the
seroprevalence of HBV and HCV in haemodialysis patients is higher than in the general population.
Even with meticulous and regular sterilization procedures for haemodialysis machines and
disposable components and practice of standard precautions against infections from blood
products and body fluids, the risk of acquitting HBV and HCV with haemodialysis treatment
remains.
Therefore it is prudent to adopt additional measures to reduce the risk:
1) All patients subjected to chronic haemodialysis treated must have their blood tested for
HBV, HBC and HIV every 3 months.
2) Patients who are positive for HbsAg should be dialyzed with separate machines at separate
haemodialysis station and not shared by seronegative patients.

3) The following rooms/facilities used for Hepatitis B sAg positive patients should be separated
from HbsAg negative patients:
a) Reprocessing area for disposable
b) Dialysis treatment room.
4) Patients who are Hepatitis C positive should also be dialysed with dedicated machine at
dedicated haemodialysis station and not to be shared with Hepatitis C negative patients.
The dialysis treatment room and the reprocessing area should be separated from Hepatitis
C negative patients.
5) For HIV positive patients, disposable should not be re-used and a separate room or
home haemodialysis is preferred. The disposal of blood lines, dialysers and dialysate is
made according to the recommendation of the Ministry of Health.

6) Seronegative patients should be immunised against hepatitis B (if HbsAb-ve) using 40ug
of vaccine at 0, 1 and 6 months with Recombivax HB or at 0,1,2 and 6 months with
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Engerix B . Staff of haemodialysis units are routinely immunized.
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7) Monitoring for patients who are Hepatitis BsAg positive;—3 monthly LFT, HbsAg; 6 monthly
alpha-fetoprotein; yearly ultrasound of the liver.
8) Monitoring for patients who are Hepatitis C positive: 3 monthly LFT; 6 monthly alpha-
fetoprotein; yearly ultrasound of the liver.

PREVENTION OF COMPLICATIONS : INFECTION
Infections Control Measures
Staff and patient education should include instruction on infection control measures for all
haemodialysis access sites.

Ministry of Health Malaysia 107