Why are we still isolating hepatitis B patients? Are guidelines based on evidence or tradition?

Carolyn Chenoweth1

1Fresenius Medical Care, carolyn.chenoweth@fmc-asia.com

 

Standard precautions were developed in 1996 with the aim of reducing transmission of blood borne viruses (BBV) between patients. A patient’s BBV status is unknown at the time of healthcare delivery, so all patients are managed with standard precautions with the assumption that anyone could potentially have a blood borne virus.

Using standard precautions, all patients are treated equally regardless of their BBV status except in haemodialysis.

Control measures for hepatitis B in dialysis were developed by the US Centers for Disease Control and Prevention (CDC) in 1977. These measures were a bundle of infection prevention and control (IPC) practices including isolation of hepatitis B patients and practices which would later become part of standard precautions. This bundled approach was successful in reducing transmission of hepatitis B in haemodialysis.

In 2001, five years after the introduction of standard precautions, the CDC updated their dialysis specific precautions which still included isolation of hepatitis B patients. The CDC recommendations for management of hepatitis B patients in haemodialysis are still referred to in haemodialysis IPC guidelines globally.

When bundled IPC practices are successful, it is assumed that all the practices in the IPC bundle are individually successful. This can result in some practices becoming accepted standard practice even though they had little or no impact on preventing transmission of infections.

There is little evidence supporting the isolation of hepatitis B patients. When developing guidelines we need to consider if standard precautions, effectively applied, are sufficient and break from the traditional view that IPC in haemodialysis should be different from general healthcare standard precautions.

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