Mitigating and preventing hepatitis B virus exposures during hemodialysis across a large regional health system

Hepatitis B virus (HBV) is one of the most prevalent health problems, with 2 billion patients infected worldwide and 350 million chronic carriers.1 In 2016, there were 20,900 new cases in the United States, a 5% increase compared to the previous 3 years and a trend expected to worsen due to the ongoing opioid crisis.2 Yearly, the number of US patients needing dialysis also increases by 5%.3 Unlike patients infected with hepatitis C or HIV, who require only standard precautions during dialysis, HBV carriers must be dialyzed on dedicated equipment in a segregated setting in which providers are aware of patients’ serostatus before each dialysis session.4,5 Given the prevalence of HBV and end-stage renal disease, and that fact that most hemodialysis is performed in more communal, multipatient settings, first-time dialysis patients could be chronic HBV carriers inadvertently dialyzed in a nonsegregated setting, especially if dialysis is urgent.6–8 The chance of having a patient’s HBV serostatus escape predialysis verification is further heightened when medical history and records are sparse, as is often the case for some populations, including refugees and recent immigrants. Setting The health system performs an average of 121,000 treatments on 810 patients in 11 dialysis units yearly. [...]9,400 of these occur in 2 inpatient units, and the remainder are performed in 8 outpatient units and 1 home unit. [...]with current dialysis machines, there is no potential for blood contamination of predialytic pathways, even if a leak occurs.