National surveillance of dialysis-associated diseases in the United States, 1987.
The Centers for Disease Control surveyed 1,630 chronic hemodialysis centers in the United States in 1987 in conjunction with the annual facility survey done by the Health Care Financing Administration. Information was obtained on the following diseases and practices: 1) hepatitis B virus (HBV) infection in patients and staff members; 2) infection control procedures for hepatitis B surface antigen (HBsAg)-positive patients; 3) frequency of HBsAg serologic screening; 4) use of hepatitis B vaccine; 5) non-A, non-B hepatitis in patients and staff members; 6) pyrogenic reactions and septicemia; 7) dialysis dementia; 8) new dialyzer syndrome; 9) high flux dialysis; 10) reuse of dialyzers, dialyzer caps, bloodlines, transducer filters; 11) cleaning and disinfection procedures; and 12) human immunodeficiency virus (HIV) infection. The response rate to a mailed questionnaire was 91%. These 1,486 centers represented 97,225 patients and 27,123 staff members. During the last 12 years, the incidence of HBV infection decreased from 3.0% to 0.2% among patients and from 2.6% to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8% to 1.7% among patients and from 0.9% to 0.4% among staff members. Hepatitis B vaccine was given by 88% of the centers. By the end of 1987, 14% of susceptible patients and 49% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1987, as a result of receiving vaccine, the prevalence of antibody to HBsAg (anti-HBs) increased from 12% to 18% among patients and from 18% to 50% among staff. The incidence of non-A, non-B hepatitis in 1987 was reported to be 1.2% among patients and 0.2% among staff members. Fourteen percent of the centers reported pyrogenic reactions among their patients, and 46% reported septicemia in the absence of pyrogenic reactions. Pyrogenic reactions were significantly more likely to be reported by centers that practiced high flux dialysis. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 29%. Among patients developing dialysis dementia, the case fatality rate was higher in those centers that used deionization (DI) without reverse osmosis (RO) (47%) compared with centers that used RO (28%) (not significant, p greater than 0.05). In 1987, 64% of centers reported that they reused disposable dialyzers. These centers treated 70% of the dialysis patient population.(ABSTRACT TRUNCATED AT 400 WORDS)
Alter
M J
MJ
Hepatitis Branch, Division of Viral Diseases, Centers for Disease Control, Atlanta, GA 30333.
Favero
M S
MS
Miller
J K
JK
Moyer
L A
LA
Bland
L A
LA
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D002487:Centers for Disease Control and Prevention, U.S.; D014487:Centers for Medicare and Medicaid Services, U.S.; D003428:Cross Infection / Q000453:epidemiology; D006509:Hepatitis B / Q000453:epidemiology*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects*; D018805:Sepsis / Q000453:epidemiology*; D014481:United States