Systematic Monitor Disinfection Is Effective in Limiting HCV Spread in Hemodialysis
Systematic Monitor Disinfection Is Effective in Limiting HCV Spread in Hemodialysis
复制标题
系统监测消毒可有效限制血液透析中丙型肝炎病毒的传播
作者：
F. Aucella;M. Vigilante;G. L. Valente;C. Stallone
背景：由于医院传播，慢性血液透析患者感染丙型肝炎病毒的风险很高。严格遵守普遍预防措施是预防的第一步，但还需要评估其他简单的工具，如系统监测消毒和对抗-HCV阳性患者使用单独的机器。方法：对4个透析中心的135例患者进行为期5年的前瞻性研究。采取了一般预防措施，但抗-丙型肝炎病毒阳性患者并未被隔离。A期为24个月，每次用次氯酸钠透析后监测消毒，过氧乙酸每周使用3次。在持续36个月的B期中，3个透析单元(77例患者)延长了A期的预防方案，而另一个单元(58例患者)也对抗-HCV阳性患者采用了单独的机器。在整个研究过程中，每2个月进行一次第三代ELISA抗-丙型肝炎病毒检测。结果：43例(31.8%)初检出抗-HCV抗体，感染率为25-39.4%。A期血清转阴1例，总阳转率0.54%/年。B期发生1例血清转阴率(单位2)，转阴率为0.36%/年。因此，5年间的平均血清转换率为0.43%/年。结论：系统监测消毒是避免血液透析患者丙型肝炎病毒感染院内传播的一种简单而有效的手段。在我们看来，它的使用是强制性的。对于抗-丙型肝炎病毒阳性患者，似乎没有必要使用单独的机器。
Background: Patients on chronic hemodialysis are at high risk of HCV infection due to nosocomial transmission. The strict adhesion to universal precautions is the first step in prevention, but other simple tools such as systematic monitor disinfection and the use of separate machines for anti-HCV-positive patients need to be evaluated. Methods: A 5-year prospective study was carried out in 4 dialysis centers enrolling 135 patients. General precautions were adopted, but anti-HCV-positive patients were not isolated. In period A, lasting 24 months, monitor disinfection was performed after each dialysis session with sodium hypochlorite; peracetic acid was also used 3 times a week. In period B, lasting 36 months, 3 dialysis units (77 patients) prolonged the same preventive protocol of period A, while another unit (58 patients) also adopted the use of separate machines for anti-HCV-positive subjects. A third-generation ELISA anti-HCV test was performed every 2 months throughout the study. Results: Anti-HCV antibodies were initially detected in 43 patients (31.8%), prevalence rate ranging from 25 to 39.4%. One seroconversion occurred in period A, with an overall seroconversion rate of 0.54%/year. Also in period B one seroconversion occurred (unit 2), seroconversion rate of 0.36%/year. Therefore the mean seroconversion rate throughout the 5 years was 0.43%/year. Conclusion: Systematic monitor disinfection may be a simple and quite effective tool to avoid nosocomial transmission of HCV infection in the hemodialysis setting. In our opinion its use is mandatory. The use of separate machines for anti-HCV-positive patients seems unnecessary.