A summary of the results of investigations on hemodialysis treatments, infection control practices, and anti-hepatitis C virus (HCV) surveillance activities are presented. Results show that six additional patients had HCV seroconversion during 2001-2008 and that the hemodialysis unit in New York City where cases of hemodialysis patients seroconverting from anti-hepatitis C virus negative to anti-HCV positive had numerous deficiencies in infection control policies, procedures, and training. A CDC editorial note is also presented.
Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Weekly March 6, 2009 / Vol. 58 / No. 8 Hepatitis C Virus Transmission National Kidney Month at an Outpatient Hemodialysis and World Kidney Day March is National Kidney Month in the United States, Unit — New York, 2001–2008 and March 12 is World Kidney Day. Both commemora- In July 2008, the New York State Department of Health tions are intended to raise awareness of kidney disease and (NYSDOH) received reports of three hemodialysis patients the importance of prevention and early detection. Kidney seroconverting from anti-hepatitis C virus (HCV) negative disease is the ninth leading cause of death in the United to anti-HCV positive in a New York City hemodialysis unit States (1), but persons with chronic kidney disease (CKD) during the preceding 6 months. NYSDOH conducted patient are more likely to die from cardiovascular disease than interviews and made multiple visits to the hemodialysis unit develop kidney failure (2). to observe hemodialysis treatments, assess infection control In 2000, approximately 26 million U.S. adults had practices, evaluate HCV surveillance activities, review medical CKD (3). However, in 1999–2004, only 42% of adults records, and conduct interviews with staff members. This report with severe kidney disease (stage 4) and fewer than 10% summarizes the results of that investigation, which found that of those with less severe disease (stages 1–3) were aware of six additional patients had HCV seroconversion during 2001– their conditions (4). CDC, in collaboration with partners, 2008 and that the hemodialysis unit had numerous deficiencies has developed the Chronic Kidney Disease Initiative, in infection control policies, procedures, and training. Of the including surveillance and screening projects and studies total of nine seroconversions, the sources for four HCV infec- of CKD costs. Additional information is available at http:// tions were identified phylogenetically and epidemiologically www.cdc.gov/diabetes/projects/kidney.htm. as four other patients in the unit. The unit’s policy for routine This year, World Kidney Day focuses on high blood patient testing for HCV infection was not in accordance with pressure, which, along with diabetes, is a leading cause of CDC recommendations, and the few recommendations fol- CKD (3). Information regarding kidney disease is available lowed were not implemented consistently. Hemodialysis units from the National Kidney Disease Education Program at http://www.nkdep.nih.gov. Information regarding should routinely assess compliance to ensure complete and World Kidney Day activities is available at http://www. timely adherence with CDC recommendations to reduce the worldkidneyday.org. risk for HCV transmission in this setting. References 1. Heron MP, Hoyert DL, Xu J, Scott C, Tejada-Vera B. Deaths: pre- liminary data for 2006. Natl Vital Stat Rep 2008;56(16):4–5. 2. Collins AJ, Li S, Gilbertson DT, Liu J, Chen SC, Herzog CA. INSIDE Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int Suppl 2003;87:S24–31. 194 Methicillin-Resistant Staphylococcus aureus Skin Infections 3. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney from an Elephant Calf — San Diego, California, 2008 disease in the United States. JAMA 2007;298:2038–47. 198 Progress Toward Poliomyelitis Eradication — Afghanistan 4. Plantinga LC, Boulware LE, Coresh J, et al. Patient awareness of and Pakistan, 2008 chronic kidney disease: trends and predictors. Arch Intern Med 202 Notices to Readers 2008;168:2268–75. 205 QuickStats department of health and human services Centers for disease Control and Prevention 190 MMWR March 6, 2009 The MMWR series of publications is published by the Coordinating The hemodialysis unit was a large, for-profit, outpatient Center for Health I
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