Effectiveness of Universal Precautions in Limiting Nosocomial Transmission of Hepatitis C Virus in Haemodialysis Units
Effectiveness of Universal Precautions in Limiting Nosocomial Transmission of Hepatitis C Virus in Haemodialysis Units
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普遍预防措施在限制丙型肝炎病毒在血液透析机构院内传播方面的有效性
DOI：
10.1177/039139889601900710
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
C. Stallone
中科院分区：
文献类型：
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作者：
F. Aucella;A. Del Giudice;A. Scarlatella;M. Di Tullio;M. Centra;G. di Giorgio;C. Stallone
尽管血液透析单位中抗-HCV阳性患者的患病率很高（1），但关于发病率和预防策略的结果相互矛盾。在这里，我们报告了我们三年随访的经验：88例接受ROT至少6个月的患者入组三个透析单位。平均随访时间为37.2个月。所有入组患者每4个月用第二代抗HCV检测试剂盒（Elisa，Ortho）检测一次，阳性标本用Riba检测试剂盒（Ortho）确认，RT-nested PCR检测血清中HCV RNA序列。医院内传播的预防措施如下。未对抗HCV阳性患者进行隔离，未使用专用机器，也未重复使用透析器。按照疾病控制中心的建议（2），对预防社区获得性感染的普遍预防措施给予了最大的关注。透析监护仪的消毒方案包括在当天最后一次透析后使用过氧乙酸或次氯酸钠溶液进行化学消毒，而在透析期间仅进行清洗循环。32例受试者（35.2%）最初检测到抗HCV抗体; 56例患者为血清阴性（表1）。（一）。抗-HCV阳性率为18.18%~ 41.37%。在随访期间，观察到5例血清转化：第一年1例，第二年2例，第三年2例（3例在医院中心，1例在各外部中心）。因此，血清转化的平均发生率为2.79% /年。除1例患者外，所有血清转化患者均为PCR阳性，除1例患者外，所有患者均为Riba 2°试验阳性（1例不确定）; 2例患者接受了输血。血清转换受试者均未在单程监测器上透析; 3例在抗HCV阳性患者的同一机器上透析：其中1例在SC前19个月也进行了输血; 1例在抗HCV阳性患者旁边透析，最后1例无这些风险状况，但在SC前15个月进行了输血（表1）。II）。到目前为止，还没有就抗-HCV阳性和阴性患者的隔离方案达成一致，就像对B型肝炎所做的那样。然而，一些作者主张隔离抗-HCV阳性患者（3，4）。如果接受分离方案，将存在许多临床和组织问题：HCV感染和抗HCV抗体检测之间的延迟; HCV基因组的巨大变异性（5）;当进行分离时，SC率下降但没有消失（6）;另一方面，存在组织问题：我们将需要多达四种不同的设施来透析有或没有HBV和HCV感染或合并感染的患者，
In spite of the high prevalence of anti-HCV positive patients in haemodialysis units (1), there are conflicting results regarding the incidence rate and, consequently, the preventive strategies. Here we report our experience with a three-year follow-up: 88 patients on ROT for at least 6 months were enrolled in three dialysis units. Mean duration of follow-up was 37.2 months. All patients enrolled were tested every 4 months with a 2nd generation antiHCV test (Elisa, Ortho); confirmation of positive samples was performed with Riba test (Ortho), RT-nested PCR was used to detect HCV RNA sequence in serum. The prevention of nosocomial transmission was set up as follows. No segregation of anti-HCV positive patients was set up, no dedicated machines were used, and no dialyzer was reused. Utmost attention was paid in applying universal precautions for prevention of community acquired infection as in Center For Disease Control Recommendation (2). The disinfection protocol for dialysis monitors included a chemical disinfection with peracetic acid or hypoclorite solution after the last dialysis session of the day, while only a washing cycle was applied between dialysis sessions. Anti-HCV antibodies were initially detected in 32 subjects (35.2%); 56 patients were seronegative (Tab. I). The prevalence of anti-HCV positive patients ranged from 18.18% to 41.37%. During the follow-up five seroconversions were observed: 1 in the first, 2 in the second, 2 in the third year (3 in the hospital center, 1 for each outside centers). Thus, mean incidence of seroconversion was 2.79% / year. All seroconverted patients but one were PCR positive and all but one had a positive Riba 2° test (one was indeterminate); two patients received blood transfusion. None of the seroconverted subjects were dialyzing on single pass monitors; three were dialyzed on the same machines of an anti-HCV positive patients: one of these was also transfused 19 months before SC; one was dialyzed next to an anti-HCV positive patient, and the last had none of these risk conditions, but was transfused 15 months before SC (Tab. II). Up to now there is no agreement on applying a segregation protocol for anti-HCV positive and negative patients as has been done for hepatitis B. However, some authors have advocated the segregation of anti-HCV positive patients (3, 4). Should an isolation protocol be accepted, there will be many clinical and organizing problems: the delay between HCV infection and detection of anti-HCV antibodies; the great variability of HCV genomes (5); when isolation was performed SC rate decreased but did not disappear (6); on the other hand, there are organizing problems: we will need up to four different facilities to dialyze patients with or without HBV and HCV infection or coinfec-