Hepatitis C in Hemodialysis Centers of Golestan Province, Northeast of Iran (2005)

Background and Aims: Nosocomial transmission of blood-borne pathogens is common in a dialysis setting. Hepatitis C virus (HCV) infection is a common problem that increases morbidity and mortality in hemodialysis patients. Blood transfusion and the duration of hemodialysis are the most important factors in HCV transmission. The aim of the study was to determine the incidence rate of HCV antibody in hemodialysis patients and its association with some factors.
Methods: In this descriptive-analytical study, HCV antibody was measured in 93 hemodialysis patients in all hospitals affiliated to Golestan University of Medical Sciences. Standard infection prevention measures in hospital settings and dialysis units were performed including serologic testing for HCV antibody for every new patient in the dialysis unit as well as routine testing of all patients. Negative cases of hepatitis C antibody (confirmed with ELISA 2nd generation and RIBA II Immunoblot methods) were selected and followed for 18 months. Some predisposing factors such as transfusion, duration of hemodialysis, medical procedures including surgery, transplantation, invasive odontology, suspicious sexual contact, diagnostic or therapeutic manipulation, tattooing, and IV drug abuse, were registered and considered. Other rare procedures like acupuncture, manicure and pedicure, blood brotherhood rituals, perinatal risk
factors, common circumcision rituals and history of abortion were also considered. We used a tight control policy through the separation of the rooms within the unit, specific hemodialysis apparatus for suspicious patients and a separate staff caring for the patients. We maintained a low rate of staff turnover in dialysis units and tried to control hepatitis B viral infection.
Results: Marital status and living area were significantly related to HCV antibody positivity. It means that more HCV antibody positive cases were observed in married people in urban areas. History of tattooing, medical procedures including surgery, transplantation, invasive odontology and IV drug usage were not significantly related to HCV antibody status. During the follow up, three cases (4.3%) converted to positive. There was a relationship between numbers of hemodialysis per week and HCV antibody positivity (P<0.001).
Conclusions:  Tight control of transmission routes and severe isolation policy in this study explains an almost ideal decrease in incidence rate of HCV antibody positivity. We suggest periodical screening programs (at least every 6 months) for blood samples that remain in the dialysis apparatus and all procedures used for hemodialysis in these specific patients to achieve a better infection control.