Introduction:
Dialysis patients are at greater risk of contracting viral infections. Several factors, such as the patient’s weak immunity, the need for frequent hospitalization, surgical procedures, or blood transfusion, are contributory factors. Immunocompromised individuals must undergo these procedures frequently in the hospital setting, and the risk of nosocomial infection (hospital-acquired infection) increases fourfold. The most common viral infections in dialysis patients are hepatitis B, hepatitis C, and occasionally HIV (Human Immunodeficiency Virus).
What Is Hepatitis?
The word hepatitis stands for inflammation of the liver, which can occur for various reasons, such as viruses, alcohol, medications, or certain immunological or genetic conditions. The most prevalent type of hepatitis is hepatitis A, B, and C. Dialysis patients are more likely to get hepatitis B and C. The virus can spread by using multi-dose medicine vials and from contaminated medical equipment. Liver infections caused by hepatitis B and C may result in severe consequences like liver cancer, liver failure, or even death. Hepatitis C cannot be prevented by vaccination, while hepatitis B can be. However, the hepatitis B vaccine should be taken before they become dependent on dialysis.
What Is Dialysis?
-
In a healthy individual, the kidneys normally filter the blood, eliminating dangerous wastes and extra fluid and converting and excreting it as urine. However, when the kidney stops working, the function of the kidney is compensated by a medical procedure called dialysis.
-
Dialysis is a technique used to eliminate waste products and excess fluid from the blood when the kidneys cease to function normally. It frequently entails redirecting blood to a machine to be cleansed.
-
Dialysis is a life-saving procedure. When the kidney fails to function normally, the body accumulates waste materials and fluid to dangerous levels. This can result in various unpleasant symptoms and even be fatal if left untreated. Dialysis removes these undesirable chemicals and fluids from the blood.
Dialysis is of two types; hemodialysis and peritoneal dialysis.
-
Hemodialysis: It involves pumping blood from the body into a device that functions as an artificial kidney and then returning the blood to the body through tubes attached to the device.
-
Peritoneal Dialysis: It uses the patient's abdominal lining as a natural filter. Waste is removed using a cleansing fluid called dialysate and rinsed in and out of the patient's abdomen in cycles. However, what is noteworthy is that of these two types of dialysis, hemodialysis has the greatest risk of causing hepatitis.
How Is Hepatitis Linked to Dialysis?
1. Hemodialysis is regarded as one of the most invasive treatments performed outside an operating room since blood is exposed to the environment directly during filtration. Additionally, even though there is a danger of infection with invasive surgery, hemodialysis patients are at exceptionally high risk.
2. According to some researchers, infections, including hepatitis, are the second most common cause of death in dialysis users. Infections linked to dialysis can develop in various systems, including the bloodstream, bones, lungs, and skin. Patients who contract infections while receiving dialysis can lose their lives, become disabled, require hospitalization, or have long-lasting infections (chronic diseases).
3. The significant risk of infections among dialysis patients is brought on by numerous circumstances, like the proximity of patients to one another, the rapid turnover of patients between sessions, and the condition of the dialysis recipient. Numerous dialysis patients have other medical issues and impaired immune systems, which increases their vulnerability to infections, particularly when preventive procedures have not been fully adhered to by the dialysis team.
4. Additionally, contributory factors that are equally crucial to an elevated risk of hepatitis C virus (HCV) infection among the hemodialysis patient population are
-
Inadequate HCV screening.
-
Excessive exposure to blood and blood products.
-
The nosocomial transmission of HCV in hemodialysis units
-
Prolonged dialysis periods.
Facts Regarding Hepatitis B and Dialysis
The hepatitis B virus (HBV) is spread through blood. Research has shown that hemodialysis patients have been found to have a higher likelihood of becoming chronic carriers of HBV in addition to having an elevated risk of infection.
Facts Regarding Hepatitis C and Dialysis
-
Patients receiving hemodialysis infected with hepatitis C (HCV) have higher mortality rates.
-
HCV infection rates in the hemodialysis population vary globally between one percent to more than 70 percent.
-
In the United States, it is 14 percent overall and ten times greater than the general population.
How Can Hepatitis Be Prevented In Dialysis Patients?
To prevent hepatitis in a dialysis patient, identifying the risk factors that can cause hepatitis is crucial. The factors that can lead to hepatitis are poor healthcare quality in hemodialysis facilities. These include:
-
Contamination of the dialysis machines.
-
Insufficient cleaning and disinfecting of the surroundings.
-
Improper interaction between medical personnel and patients.
-
Equipment.
-
Wrong handling of parenteral drugs.
The following are the preventive measures for HBV and In-Hospital Dialysis:
-
All dialysis patients must have the HBV (hepatitis B virus) vaccine.
-
To avoid the nosocomial (hospital-acquired disease) spread of bloodborne pathogens, including hepatitis virus, hemodialysis units should ensure installation and adherence to stringent infection-control protocols.
-
It is recommended that hemodialysis units include regular observational audits of infection-control practices in their performance reviews.
-
Sufficient time should be given between dialysis sessions and machine and surface disinfection.
-
During dialysis, place gloves strategically around the device to allow easy access.
-
When choosing new equipment, it is important to consider disinfection efficiency.
-
Strict adherence to the recommended infection control procedures, ongoing monitoring of HBV markers in hemodialysis patients, immunization of patients and staff, and hepatitis B treatment for those on hemodialysis should be observed.
-
Regardless of prior vaccination, every new patient in a dialysis center must have their HBV markers checked. All patients in the center should undergo routine screenings every three to four months.
-
It is not recommended to isolate HCV-infected individuals or use special equipment unless necessary during local outbreaks.
Conclusion:
Despite being less frequent, HBV and HCV remain significant sources of health hazards among dialysis patients. With each additional dialysis session, the risk of exposure rises, reaching its peak in patients on maintenance hemodialysis. Therefore, countering their spread and lowering the risk of long-term consequences is important.
