The Centers for Disease Control surveyed 1,630 chronic hemodialysis centers in the United States in 1987 in conjunction with the annual facility survey done by the Health Care Financing Administration. Information was obtained on the following diseases and practices: 1) hepatitis B virus (HBV) infection in patients and staff members; 2) infection control procedures for hepatitis B surface antigen (HBsAg)-positive patients; 3) frequency of HBsAg serologic screening; 4) use of hepatitis B vaccine; 5) non-A, non-B hepatitis in patients and staff members; 6) pyrogenic reactions and septicemia; 7) dialysis dementia; 8) new dialyzer syndrome; 9) high flux dialysis; 10) reuse of dialyzers, dialyzer caps, bloodlines, transducer filters; 11) cleaning and disinfection procedures; and 12) human immunodeficiency virus (HIV) infection. The response rate to a mailed questionnaire was 91%. These 1,486 centers represented 97,225 patients and 27,123 staff members. During the last 12 years, the incidence of HBV infection decreased from 3.0% to 0.2% among patients and from 2.6% to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8% to 1.7% among patients and from 0.9% to 0.4% among staff members. Hepatitis B vaccine was given by 88% of the centers. By the end of 1987, 14% of susceptible patients and 49% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1987, as a result of receiving vaccine, the prevalence of antibody to HBsAg (anti-HBs) increased from 12% to 18% among patients and from 18% to 50% among staff. The incidence of non-A, non-B hepatitis in 1987 was reported to be 1.2% among patients and 0.2% among staff members. Fourteen percent of the centers reported pyrogenic reactions among their patients, and 46% reported septicemia in the absence of pyrogenic reactions. Pyrogenic reactions were significantly more likely to be reported by centers that practiced high flux dialysis. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 29%. Among patients developing dialysis dementia, the case fatality rate was higher in those centers that used deionization (DI) without reverse osmosis (RO) (47%) compared with centers that used RO (28%) (not significant, p > 0.05). In 1987, 64% of centers reported that they reused disposable dialyzers. These centers treated 70% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses was 11 (range, 1–85), and the mean maximum number of times a disposable dialyzer was reused was 27 (range, 4–119). Chemical germicides used for reprocessing dialyzers included formaldehyde, Renalin (a peracetic acid-hydrogen peroxide-based germicide), and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. Pyrogenic reactions occurring in clusters were more often reported by centers that reused disposable dialyzers than by centers that did not (4% versus 0.6%, p < 0.05). This increased risk was mostly associated with centers that used manual systems for reprocessing regardless of the number of dialyzer reuses. Thirteen percent of centers reported reusing bloodlines, 5% reported reusing transducer filters, and 54% reported reusing dialyzer caps. Reuse of these disposables was not associated with any increased risk of HBV infection in either patients or staff or of pyrogenic reactions or septicemia. “New dialyzer syndrome” was reported by 39% of the dialysis centers in 1987, a frequency similar to that reported in 1985 and 1986. from 1985 to 1987, the percentage of centers that reported providing dialysis for patients with HIV infection increased from 11% to 24%. The number of dialysis patients known to be infected with HIV also increased from 0.3% to 1.0%. Those centers that reported providing dialysis for HIV infected patients were located in 34 states, the District of Columbia, Puerto Rico, and the Virgin Islands.xs
©1989 American Society of Artificial Internal Organs
