Status Quo Of Hemodialysis Agency In Four Cities And Risk Factors Of HCV Infection In Hemodialysis Patients

Objectives To investigate the service state of hemodialysis centres and the risk factors of hepatitis C virus (HCV) among hemodialysis patients in 4 cities, in order to provide guidance for the prevention and control strategy of HCV in hemodialysis patients.Methods A cross-sectional stdudy was undertaken in the combination of quantitative and qualitative research From August to October 2014. The first questionnaire surveys were conducted in medical staffs to understand the service state of the hemodialysis institutions. The second questionnaire survey was conducted in hemodialysis patients. The data collected from hemodialysis patients were divided into anti-HCV positive group and anti-HCV negative group, and the chi-square test and multi-factor logistic regression were used to explore the risk factors of HCV infection in hemodialysis patients.Results1. There were a total of 348 dialysis beds,346 dialysis machines in the 12 hemodialysis institutions.84546 dialysis treatments had been implemented in the first half of 2014. The prevalence of HCV, HBV, syphilis and HIV were respectively 2.26%,8.58%,0.84%and 0.00%; the prevalence of HCV in hemodialysis patients is higher than the general population in China, and higher than the average level of four cities (1.76%).2. The nurses of the 12 hemodialysis institutions were responsible for the operation of the dialysis machines.43 (64.2%) medical staffs showed every nurses need to operate 5 to 6 dialysis machine at the same time. Hemodialysis patients with HCV infection were treated with isolation in all of the 12 hemodialysis institutions,11 hemodialysis institutions set up emergency dialysis machine,1 hemodialysis institutions exist dialyzer reuse,2 hemodialysis institutions have the ability of HCV RNA detection. The sharing of treatment items was existed in the process of dialysis treatment operation; the incidence of blood transfusion and dialyser rupture in hemodialysis patients is fewer than that in the past.3. The multi-factor logistic regression analysis is conducted to select related and main factors. The resaults show that a history of kidney transplant(AOR=8.500, 95%CI:3.170～22.794); length of time on hemodialysis (AOR=3.682,95%CI: 1.544～8.784); compared with no history of blood transfusionblood transfusions, blood transfusions before 1998(AOR=4.713,95%CI:1.494～14.870) and after 1998 (AOR=3.532,95%CI:1.055～11.828) were the main risk factors of hepatitis C infection of hemodialysis patients.Conclusions The service scale of 12 hemodialysis institutions is large, the prevalence of HCV infection of hemodialysis patients was higher than the general population. Hemodialysis patients with HCV infection were treated with isolation. However the ability of HCV RNA detection of the hemodialysis institutions was low, only 2 hemodialysis institutions had the ability. Many factors were related to the hemodialysis patients with HCV infection. The result of the survey shows:the risk factors associated with dialysis treatmeat was the length of time on hemodialysis, the other risk factors were a history of kidney transplant and blood transfusions. Universal infection control measures were very important in the prevention of the blood-borne diseases transmission. The result of the survey shows:strict adherence to infection control measures should be emphasized to reduce the risk of the transmission of HCV in hemodialysis in patients.