The magnitude of hepatitis C and hepatitis B virus infections in chronic hemodialysis patients with end stage renal disease in a low-resource healthcare setting in Vietnam: implications for infection control

摘要

BackgroundHepatitis C (HCV) and B virus (HBV) infections are common problems among chronic hemodialysis patients in low-resourced countries. This thesis aims to identify the magnitude of these infections and the infection control (IC) challenges associated with the prevention of HCV and HBV infections in a satellite hemodialysis unit in Vietnam.MethodsThe thesis is a series of published and submitted peer-review journal articles that describe (1) the prevalence and 2-year incidence density of HCV and HBV infections (2) the treatment-related and socioeconomic risks and poor health services preparedness associated with acquiring these infections (3) an investigation of a large HCV outbreak (4) the IC practices and barriers possibly associated with the outbreak and (5) the application of quality control chart for monitoring these infections. FindingsHCV and HBV incidence density rates were 5 (95%CI 3-9) and 2 (95%CI 1-4) new cases per 1,000 person-months respectively. Periodic HCV and HBV prevalence rates were higher than those in the Vietnamese general community. Overall, 99% of patients reused dialyzers and none were HBV vaccinated. Having a HBV positive sexual partner increased the risk of acquiring HBV while the risk for HCV included blood transfusion, multiple hemodialysis unit visits and prolonged hemodialysis. Over the 2 year follow-up, an outbreak of HCV at the Unit was identified and the likely mode of transmission was suboptimal handwashing compliance and reuse of gloves with multiple patients during a single nursing care activity provided to consecutive patients, and indirect contamination of patients’ dialyzers. Shewhart charts effectively demonstrated all alarming increases in HBV and HCV infections.ConclusionStrict adherence to IC measures facilitated by a checklist and an audit system of IC resources and practices are pivotal strategies in the prevention of HCV and HBV infections. Single patient-centered care must be strictly adhered. Single-use of dialyzer and HBV vaccination should be recommended. Guidelines for reprocessing and storage of dialyzers for HCV and HBV infected patients must be followed. Stringent screening of blood products remains a priority in Vietnam. Shewhart control chart could detect early signs of changes in HCV and HBV infections.