Renal Unit BBVs

Question 1

Which guidelines advise about managing screening for infections in renal unit?

Answer 1

Department of Health guidelines for Renal dialysis/ transplant units

Question 2

Dialysis patient has been abroad on holiday to low risk country

When to screen for infection?

Do they need segregated dialysis?

Answer 2

Low risk country - UK/ Europe/ US/ Aus/ NZ/ Japan - just regular screening. eg HBsAg/ anti-HCV every 3 months

Question 3

Dialysis patient has been abroad on holiday to high risk country

When to screen for infection?

Do they need segregated dialysis?

Answer 3

High risk country - India/ Africa

Plan 1 -
test HBsAg/ HCV on return
test every 2 weeks, for 2 months
segregate dialysis machine for 2 months
HIV test if at risk

Plan 2 - if virology lab testing available
test HBsAg/ HCV on return
test weekly for 4 weeks
only segregate if turns positive
HIV test if at risk

Question 4

Dialysis patient has been abroad and had dialysis

You plan to test anyway

What questions would you ask to ascertain their risk of acquiring BBV?

Answer 4

• While abroad did you have any blood transfusions?
• While abroad did you have any surgery or dental treatment?
• While abroad were you ill, requiring hospital admission?

Did you inject drugs?

Did you have any high risk sexual behaviour?

Question 5

Possible outbreak of BBV in renal unit

What steps should be taken?

Answer 5

Identify outbreak
- isolate and segregate source patient
- period of enhanced surveillance
- ensure basic IP&C - hand washing/ basic precautions

HBV
- Exposed cohort should be tested for HBsAg
- if previously immune (anti-HBs >100) - give booster. Stop testing if negative
- if previously non-immune (anti-HBs <100) - consider immunisation and HBIG. Test every week, for 3 months after last exposure

HCV
- exposed cohort should be tested for HCV RNA, every 2 weeks for 3 months after last exposure