Cross Infections in Dialysis Units

A third of people who are on maintenance hemodialysis eventually get infected with a chronic viral disease. Isn’t this shocking?

The disease is usually Hepatitis C. Some people also get infected with Hepatitis B or HIV. Hepatitis C is a disease that affects the liver. 85% of people with Hepatitis C proceed to liver cirrhosis necessitating a liver transplant.

Cross infections happen when the blood of an infected individual comes into contact with the blood of an individual who is not infected. This can happen in dialysis units when the patient undergoes a blood transfusion and the blood of the donor has not been screened properly. Cross infections can also occur due to improper processes followed in the dialysis units. Especially during washing of dialyzers and bloodlines, there is a high chance of this happening. Therefore, it is advisable to opt for single use of dialyzer and bloodlines if you can afford it.

Once a dialyzor is infected with a virus such as Hepatitis C, there are more hurdles for a transplant. Most centers prefer giving a cadaveric kidney to a person who is negative (virus free) rather than someone who is positive. The treatment after a transplant also becomes more complex because the doctors have to keep in mind that the immunosuppression drugs can cause a flare up of the Hepatitis C virus causing further damage to the liver. Every decision needs to be taken keeping this in mind.

There are treatments available for Hepatitis C but the chances of successfully eliminating the virus are still not 100%. This is because the virus is best treated with a combination of two drugs – pegylated interferon and ribavirin. The first actually reduces the viral load (number of virus copies per ml of blood) but the second actually helps keep it down. Ribavirin, however, causes severe anemia in people on dialysis. So, people on dialysis are treated only with pegylated interferon. This further reduces the chances of successfully treating the disease in the dialysis population.

There are however, many people on dialysis who are successfully treated for Hepatitis C. So, if you’re on dialysis and are positive, definitely consider treating it.

It is however very important for you, as a dialysis patient to dialyze at a unit that takes cross infection prevention very seriously. Units must follow stringent processes. There are a set of published guidelines by the Center for Disease Control that lay down the procedures to be followed and the precautions to take to prevent cross infections in dialysis units. All centers must actively follow these guidelines.