Monitoring of High-Risk Areas: Dialysis Units

  • Ashwini Gupta


Patients having chronic kidney disease (CKD) are more susceptible to a wide range of infections due to their unique position whereby they have more chances of exposure to various pathogens due to decreased immune defenses and increased interventions especially in patients on hemodialysis. According to Indian CKD registry data, of all the end-stage renal disease (ESRD) patients receiving any dialysis, more than 86 % are on maintenance hemodialysis [1].


Hemodialysis Patient Hepatitis Delta Virus Dialysis Unit Hepatitis Delta Virus Infection Pyrogenic Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrol. 2012;13:10.PubMedCrossRefGoogle Scholar
  2. 2.
    Khan IH, Catto GR. Long-term complications of dialysis: infection. Kidney Int. 1993;41(Suppl):S143–8.Google Scholar
  3. 3.
    Favero MS, Petersen NJ, Carson LA, Bond WW, Hindman SH. Gram-negative water bacteria in hemodialysis systems. Health Lab Sci. 1975;12(4):321–34.PubMedGoogle Scholar
  4. 4.
    Basok A, Vorobiov M, Rogachev B, Avnon L, Toybin D, Hausmann M, et al. Spectrum of mycobacterial infections: tuberculosis and Mycobacterium other than tuberculosis in dialysis patients. Isr Med Assoc J. 2007;9(6):448–51.PubMedGoogle Scholar
  5. 5.
    Favero MS, Petersen NJ, Boyer KM, Carson LA, Bond WW. Microbial contamination of renal dialysis systems and associated health risks. Trans Am Soc Artif Intern Organs. 1974;20A:175–83.PubMedGoogle Scholar
  6. 6.
    Nystrand R. Microbiology of water and fluids for hemodialysis. J Chin Med Assoc. 2008;71(5):223–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Leitlinie für angewandte hygiene in dialysezentren. 2 Auflage. Arbeitskreis für angewandte hygiene in dialysezentren. Pabst Verlag. 2005. ISBN 3-89967-272-0. [In German].Google Scholar
  8. 8.
    Kawanishi H, Akiba T, Masakane I, Tomo T, Mineshima M, Kawasaki T, et al. Standard on microbiological management of fluids for hemodialysis and related therapies by the Japanese society for dialysis therapy 2008. Ther Apher Dial. 2009;13(2):161–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Svensk Läkemedelsstandard SLS 2007. Svenska farmakopékommittén, Uppsala. 2007. ISBN 91-973998-6-8. [In Swedish].Google Scholar
  10. 10.
    Canadian Standards Association. Water treatment equipment and water quality requirements for hemodialysis, CSA standard, vol. Z364.2.2-03. Mississauga: Canadian Standards Association; 2003.Google Scholar
  11. 11.
    AAMI. American national standard: reuse of hemodialyzers, ANSI/AAMI RD-47. Arlington: Association for the Advancement for Medical Instrumentation; 2008.Google Scholar
  12. 12.
    Arduino MJ. Microbiologic quality of water used for hemodialysis. Contemp Dial Nephrol. 1996;17:17–9.Google Scholar
  13. 13.
    Petersen NJ, Boyer KM, Carson LA, Favero MS. Pyrogenic reactions from inadequate disinfection of a dialysis fluid distribution system. Dialysis Transplant. 1978;7:52–7.Google Scholar
  14. 14.
    Bland LA, Favero MS, editors. Microbial contamination control strategies for hemodialysis systems, Plant, technology, and safety management, vol. 3. Oakbrook Terrace: Joint Commission on Accreditation of Healthcare Organizations; 1989.Google Scholar
  15. 15.
    Townsend TR, Wee SB, Bartlett J. Disinfection of hemodialysis machines. Dial Transplant. 1985;14:274–87.Google Scholar
  16. 16.
    Favero MS, Petersen NJ. Microbiologic guidelines for hemodialysis systems. Dial Transplant. 1977;6:34–6.Google Scholar
  17. 17.
    Alter MJ, Favero MS, Moyer LA, Bland LA. National surveillance of dialysis-associated diseases in the United States, 1989. ASAIO Trans. 1991;37(2):97–109.PubMedGoogle Scholar
  18. 18.
    Kaplowitz LG, Comstock JA, Landwehr DM, Dalton HP, Mayhall CG. A prospective study of infections in hemodialysis patients: patient hygiene and other risk factors for infection. Infect Control Hosp Epidemiol. 1988;9(12):534–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Tokars JI, Miller ER, Stein G. New national surveillance system for hemodialysis-associated infections: initial results. Am J Infect Control. 2002;30(5):288–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Klevens RM, Edwards JR, Andrus ML, Peterson KD, Dudeck MA, Horan TC. Dialysis surveillance report: National Healthcare Safety Network (NHSN)-data summary for 2006. Semin Dial. 2008;1(1):24–8.Google Scholar
  21. 21.
    Klevens RM, Tokars JI, Andrus M. Electronic reporting of infections associated with hemodialysis. Nephrol News Issues. 2005;19(7):37–843.PubMedGoogle Scholar
  22. 22.
    Bonomo RA, Rice D, Whalen C, Linn D, Eckstein E, Shlaes DM. Risk factors associated with permanent access-site infections in chronic hemodialysis patients. Infect Control Hosp Epidemiol. 1997;18(11):757–61.PubMedCrossRefGoogle Scholar
  23. 23.
    NKF: III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(1 Suppl 1):S137–81.Google Scholar
  24. 24.
    NKF. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S248–73.Google Scholar
  25. 25.
    CDC. Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002;51(RR-10):1–29.Google Scholar
  26. 26.
    Dinwiddie L. Cleansing agents used for hemodialysis catheter care. Nephrol Nurs J. 2002;29(6):599–613.PubMedGoogle Scholar
  27. 27.
    Mermel LA. Prevention of intravascular catheter infections – insights and prospects for hemodialysis catheters. Nephrologie. 2001;22(8):449–51.PubMedGoogle Scholar
  28. 28.
    Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris JS, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001;32(9):1249–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Alter MJ, Favero MS, Maynard JE. Impact of infection control strategies on the incidence of dialysis-associated hepatitis in the United States. J Infect Dis. 1986;153(6):1149–51.PubMedCrossRefGoogle Scholar
  30. 30.
    Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial. 2005;18(1):52–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Jaiswal S, Chitnis D, Salgia P, Sepaha A, Pandit C. Prevalence of the hepatitis virus among chronic renal failure patients on hemodialysis in central India. Dial Transplant. 2002;31:234–8.Google Scholar
  32. 32.
    Sudan SS, Sharma RK. Prevalence of hepatitis B & C in CRF patients on haemodialysis. Accessed 15 Dec 2012.
  33. 33.
    Chandra M, Khaja MN, Hussain MM, Poduri CD, Farees N, Habeeb MA, et al. Prevalence of hepatitis B and hepatitis C viral infections in Indian patients with chronic renal failure. Intervirology. 2004;47:374–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Chawla NS, Sajiv CT, Pawar G, Pawar B. Hepatitis B and C Virus infections associated with renal replacement therapy in patients with end stage renal disease in a tertiary care hospital in India – prevalence, risk factors and outcome. Indian J Nephrol. 2005;15:205–13.Google Scholar
  35. 35.
    Alter HJ, Seeff LB, Kaplan PM, McAuliffe VJ, Wright EC, Gerin JL, et al. Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure. N Engl J Med. 1976;295(17):909–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Bond WW, Favero MS, Petersen NJ, Gravelle CR, Ebert JW, Maynard JE. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981;1(8219):550–1.PubMedCrossRefGoogle Scholar
  37. 37.
    Favero MS, Bond WW, Petersen NJ, Berquist KR, Maynard JE. Detection methods for study of the stability of hepatitis B antigen on surfaces. J Infect Dis. 1974;129(2):210–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Favero MS, Maynard JE, Petersen NJ, Boyer KM, Bond WW, Berquist KR, et al. Letter: hepatitis-B antigen on environmental surfaces. Lancet. 1973;2(7843):1455.PubMedCrossRefGoogle Scholar
  39. 39.
    Alter MJ, Ahtone J, Maynard JE. Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit. Ann Int Med. 1983;99(3):330–3.PubMedCrossRefGoogle Scholar
  40. 40.
    Carl M, Francis DP, Maynard JE. A common-source outbreak of hepatitis B in a hemodialysis unit. Dial Transplant. 1983;12:222–9.Google Scholar
  41. 41.
    Rangel MC, Coronado VG, Euler GL, Strikas RA. Vaccine recommendations for patients on chronic dialysis. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Semin Dial. 2000;13(2):101–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR. 2006;55(RR-16):1–33. quiz CE31–34.PubMedGoogle Scholar
  43. 43.
    Hoofnagle JH, Di Bisceglie AM. Serologic diagnosis of acute and chronic hepatitis. Sem Liver Dis. 1991;11(2):73–83.CrossRefGoogle Scholar
  44. 44.
    McMahon BJ, Alberts SR, Wainwright RB, Bulkow L, Lanier AP. Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers. Arch Int Med. 1990;150(5):1051–4.CrossRefGoogle Scholar
  45. 45.
    CDC. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR. 2001;50(RR-5):1–43.Google Scholar
  46. 46.
    Bendinelli M, Pistello M, Maggi F, Vatteroni M. Blood-borne hepatitis viruses: hepatitis B, C, D, and G viruses and TT virus. In: Specter S, Hodinka RL, Young SA, editors. Clinical virology manual. 3rd ed. Washington, DC: ASM Press; 2000.Google Scholar
  47. 47.
    CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 1998;47(RR19):1–39.Google Scholar
  48. 48.
    Moyer LA, Alter MJ. Hepatitis C virus in the hemodialysis setting: a review with recommendations for control. Semin Dial. 1994;7:124–7.CrossRefGoogle Scholar
  49. 49.
    Salunkhe PN, Naik SR, Semwal SN, Naik S, Kher V. Prevalence of antibodies to hepatitis C virus in HBsAg negative haemodialysis patients. Indian J Gastroenterol. 1992;11(4):164–5.PubMedGoogle Scholar
  50. 50.
    Chadha MS, Arankalle VA, Jha J, Banerjee K. Prevalence of hepatitis B and C virus infection among hemodialysis in Pune (Western India). Vox Sang. 1993;64:127–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Sumathi S, Valliammai T, Thyagarajan SP, Malathy S, Madanagopalan N, Sankarnarayan V, et al. Prevalence of hepatitis C virus infection in liver diseases, renal diseases and voluntary blood donors in South India. Indian J Med Microbial. 1993;11(4):291–7.Google Scholar
  52. 52.
    Agarwal SK, Dash SC, Irshad MC. Hepatitis C virus infection during hemodialysis in India. J Assoc Phys India. 1999;47:1139–43.Google Scholar
  53. 53.
    Reddy AK, Murthy KV, Lakshmi V. Prevalence of HCV infection in patients on haemodialysis: survey by antibody and core antigen detection. Indian J Med Microbiol. 2005;23:106–10.PubMedCrossRefGoogle Scholar
  54. 54.
    Kamili S, Krawczynski K, McCaustland K, Li X, Alter MJ. Infectivity of hepatitis C virus in plasma after drying and storing at room temperature. Infect Control Hosp Epidemiol. 2007;28(5):519–24.PubMedCrossRefGoogle Scholar
  55. 55.
    Niu MT, Coleman PJ, Alter MJ. Multicenter study of hepatitis C virus infection in chronic hemodialysis patients and hemodialysis center staff members. Am J Kidney Dis. 1993;22(4):568–73.PubMedGoogle Scholar
  56. 56.
    Petrosillo N, Gilli P, Serraino D, Dentico P, Mele A, Ragni P, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis. 2001;37(5):1004–10.PubMedCrossRefGoogle Scholar
  57. 57.
    Selgas R, Martinez-Zapico R, Bajo MA, Romero JR, Munoz J, Rion C, et al. Prevalence of hepatitis C antibodies (HCV) in a dialysis population at one center. Perit Dial Int. 1992;12(1):28–30.PubMedGoogle Scholar
  58. 58.
    Thompson ND, Novack RT, Datta D, Cotter S, Arduino MJ, Patel PR, et al. Hepatitis C virus transmission in the hemodialysis setting: importance of infection control practices and aseptic technique. Infect Control Hosp Epidemiol. 2009;30:900–3.PubMedCrossRefGoogle Scholar
  59. 59.
    Alter MJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis. 1997;1:559–68.PubMedCrossRefGoogle Scholar
  60. 60.
    Alter MJ. Prevention of spread of hepatitis C. Hepatology. 2002;26(5 Suppl 1):S93–8.CrossRefGoogle Scholar
  61. 61.
    CDC. Guidelines for laboratory testing and result testing for hepatitis C virus. MMWR. 2003;52(RR3):1–15.Google Scholar
  62. 62.
    Busch MP, Kleinman SH, Jackson B, Stramer SL, Hewlett I, Preston S. Committee report. Nucleic acid amplification testing of blood donors for transfusion-transmitted infectious diseases: report of the Interorganizational Task Force on Nucleic Acid Amplification Testing of Blood Donors. Transfusion. 2000;40(2):143–59.PubMedCrossRefGoogle Scholar
  63. 63.
    Williams IT, Gretch D, Fleenor M. Hepatitis C RNA concentration and chronic hepatitis in a cohort of patients followed after developing acute hepatitis C. In: Margolis HS, Alter MJ, Liang TJ, Dienstag JL, editors. Viral hepatitis and liver disease. Atlanta: International Medical Press; 2000. p. 341–4.Google Scholar
  64. 64.
    Thomas DL, Astemborski J, Rai RM, Anania FA, Schaeffer M, Galai N, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA. 2000;284(4):450–6.PubMedCrossRefGoogle Scholar
  65. 65.
  66. 66.
    Arduino MJ, Tokars JI, Lyerla R, et al. Preventing health-care associated transmission of bloodborne pathogens in hemodialysis facilities. Sem Infect Control. 2001;1(1):49–60.Google Scholar
  67. 67.
    Arduino MJ. How should dialyzers be reprocessed? Semin Dial. 1998;11(5):282–4.CrossRefGoogle Scholar
  68. 68.
    Hadler SC, Fields HA. Hepatitis delta virus. In: Belshe BB, editor. Textbook of human virology. St. Louis: Mosby; 1991.Google Scholar
  69. 69.
    Favero MS. Transmission of HIV in dialysis units. ANNA J. 1993;20(5):599–600.PubMedGoogle Scholar
  70. 70.
    Guo H, Liu J, Collins AJ, Foley RN. Pneumonia in incident dialysis patients—the United States Renal Data System. Nephrol Dial Transplant. 2008;23(2):680–6.PubMedCrossRefGoogle Scholar
  71. 71.
    CDC. Guideline for hand hygiene in health-care settings. MMWR. 2002;51 RR16Google Scholar
  72. 72.
    Fogel MA, Nussbaum PB, Feintzeig ID, Hunt WA, Gavin JP, Kim RC. Cefazolin in chronic hemodialysis patients: a safe, effective alternative to vancomycin. Am J Kidney Dis. 1998;32(3):401–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2014

Authors and Affiliations

  1. 1.Department of NephrologySir Ganga Ram HospitalNew DelhiIndia

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