Staff knowledge, adherence to infection control recommendations and seroconversion rates in hemodialysis centers in Khartoum

We evaluated hemodialysis (HD) staff knowledge, adherence to infection control recommendations and seroconversion rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) in 13 centers that continuously provided HD services in Khartoum State between June 2009 and November 2010. The knowledge of 182 HD staff members was evaluated by a self-filled questionnaire. Relevant data were obtained from 1011 HD patients by direct interviews and record review. Adherence to infection control recommendations was evaluated by direct observation. HD staff members achieved a median score of 81% in knowledge evaluation (range 44-100%). Better scores were achieved by more experienced staff. We identified serious gaps in knowledge related to the environmental risk of viral transmission. Regular screening by enzyme-linked immunoassay (ELISA) was performed in 46% of centers. Only half susceptible patients were vaccinated against HBV. Staff dedicated for treatment of HBV positive patients were found in only 57% of centers that served such patients. Hand washing recommendations were strictly observed in 15% of centers, disinfection of HD stations between patients was strictly observed in 23% of centers, medications were prepared in a separate area in 8% of centers and delivered separately to each patient in none of the centers. There were 2.5 HCV seroconversions and 0.6 HBV seroconversions per 100 patient-years. Center characteristics that predicted HCV seroconversion were accommodation of HCV-positive patients in the same center, using ELISA for patient screening, and assigning more than 3 patients for one HD nurse. There are serious gaps in HD staff knowledge and adherence to infection control recommendations. A structured training program for HD staff members is urgently required.