Introducción:

Patients on routine hemodialysis (HD) present a high prevalence of anti-HCV+.Both incidence and prevalence studies have documented an association between anti-HCV positivity and increasing years on dialysis, independent of blood transfusion

All studies and investigations about HCV outbreaks associated with dialysis indicate that HCV transmition can be avoided by a correct implementation and maintenance of infection-control practices and the CDC published the routine precautions for the care of all hemodialysis patients

Strict adherence to these precautions should prevent the nosocomial transmission of HCV in HD patients and the CDC doesn´t recommend the isolation of threse patients.

Some authors have adopted special precautions. On account of the high prevalence of HCV+ in our Centers and after the reinforcement of all these precautions and the persistence of new cases, we developed a strategy not described before in order to prevent the nosocomial transmission of HCV.

Materials and Methods

We separate the patients (antiHCV+ and antiHCV-) in different turns but in the same rooms.We separate the turns during an hour for cleaning and decontamination with personnel and patients evacuation.Sodium hipoclorite 1% was used for decontamination.

We evaluated all patients (n=173) in HD in our 3 centers from2,5 years before the isolation till 4,5 years (Jun 1994/Jun 2001) after isolation with bianual serology (Elisa 3rd generation) and confirmed by PCR Nested amplified. No patient entered HD with antiHCV+ ,we did not detect drug addiction or HbsAtg + patients.

Results:

The rate of seroconvertion before the isolation was of 0.96 pat/year exposure and 0 pat/year after the follow up period ( 42 months ).

Conclusion

The strict adherence to these precautions and additionaly the separation by shifts allowed us to achieve an incidence of seroconvertion of 0% after the following 42 months.

We think that this is an efficient and less costly methodology than others proposed before and does not require dedicated personnel,rooms or machines and can be used to avoid the nosocomial transmission until an effficient vaccine is available.

Bibliography