title: Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients.
abstract: OBJECTIVE
  To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Chronic hemodialysis facilities in the United States.
  
  
  METHODS
  Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30-150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate.
  
  
  METHODS
  Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation.
  
  
  RESULTS
  The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%-11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4-3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3-3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0-2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8-5.2]), patient-to-staff ratio of at least 7 : 1 (OR, 2.4 [95% CI, 1.4-4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3-4.4]).
  
  
  CONCLUSIONS
  This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Gayle
authors.initials: G
authors.lastname: Shimokura
authors.forename: Feng
authors.initials: F
authors.lastname: Chai
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Samsa
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Xia
authors.forename: Omana V
authors.initials: OV
authors.lastname: Nainan
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Tobler
authors.forename: Michael P
authors.initials: MP
authors.lastname: Busch
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Alter
mesh_terms: D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D004203:Disinfection; D017743:Equipment Reuse; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005791:Patient Care / Q000379:methods* / Q000706:statistics & numerical data; D010559:Personnel Management; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013048:Specimen Handling / Q000379:methods; D013997:Time Factors