隔离技术对血透患者丙肝感染预防作用有限？

紫陌红尘

不同血透中心的血透患者HCV感染率从10%到60%不等。血透期间对HCV患者的隔离问题存在争议，CDC指南不建议对这些患者进行隔离，相反，证据表明，HCV患者血透期间隔离作用有限。
结合上述观点，迷茫了。联想国内发生的血透丙肝事件，真的希望能有详细的明确感染暴发隐患环节的教训介绍能供大家学习。

原文：Nephron Clin Pract. 2011;117(4):c328-32. doi: 10.1159/000319984. Epub 2010 Nov 3.
Hemodialysis of patients with HCV infection: isolation has a definite role.隔离技术对血透患者丙肝感染预防作用有限
Agarwal SK.
SourceDepartment of Nephrology, All India Institute of Medical Sciences, New Delhi, India. skagarwal58@yahoo.co.in

Abstract
HCV infection in patients on hemodialysis varies from 10 to 60% in various centers. There is controversy regarding the isolation of patients with HCV infection during hemodialysis. Guidelines developed by the Centers for Disease Control and Prevention do not suggest isolation of these patients. In this opposite view, evidence is being given to support the view that there is a definite role of isolation of HCV-infected patients during hemodialysis.

紫陌红尘

找找相关的环节，透析机在HCV的传播中并不那么重要，应强调透析环境的卫生控制。

原文：Hepat Mon. 2013 Jan;13(1):e5912. doi: 10.5812/hepatmon.5912. Epub 2013 Jan 20.
Comparison of contamination passing through Iranian and non- Iranian filters of ultra filtration dialysis machines in patients with hepatitis C.
Bashiri H, Omrani H, Mami M, Rezaee M.
SourceDepartment of Internal Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.

Abstract
BACKGROUND: Hepatitis C is one of the common infectious diseases throughout the world. About 170 million people worldwide are infected with Hepatitis C virus. The most common route of transmission is direct blood-to-blood contacts.

OBJECTIVES: This study conducted to compare the amount of contamination might be found in ultra-filtered liquid passed through 2 kinds of filters ps10 (Mediatex, Iran) and Lups (Bio brand, Germany).

PATIENTS AND METHODS: To achieve the goal, infected dialysis patients in which hepatitis C virus infection was detected by Elisa and PCR were selected.

RESULTS: As shown in data the first stage of PCR test using ps10 filters all samples were negative. In the second step performed in later dialysis steps (with Lups filters), no infection was recorded, too.

CONCLUSIONS: Our results showed that dialysis machines do not have an important role in transmission of hepatitis C infection and sanitation control in the environment of dialysis should be emphasized.

紫陌红尘

手卫生仍是重点！国外血透丙肝事件原因查找：此次暴发，患者间HCV传播主要通过医务人员手实现。但是，经血透机传播的可能性并未被排除
原文：Infect Control Hosp Epidemiol. 2005 Sep;26(9):752-60.
A large nosocomial outbreak of hepatitis C virus infections at a hemodialysis center.
Savey A, Simon F, Izopet J, Lepoutre A, Fabry J, Desenclos JC.
SourceC. Clin Sud-Est, Centre Hospitalier Lyon Sud, Lyon, France. anne.savey@chu-lyon.fr

Erratum in
Infect Control Hosp Epidemiol. 2005 Oct;26(10):810.
Abstract
OBJECTIVE: To identify modes of HCV transmission during an outbreak of HCV infection in a hemodialysis unit.

DESIGN: An epidemiologic study, virologic analysis, assessment of infection control practices and procedures, and technical examination of products and dialysis machines.

SETTING: A private hemodialysis unit treating approximately 70 patients.

PATIENTS: Detection of HCV RNA by PCR was performed among patients receiving dialysis in 2001. Case-patients were patients who had a first positive result for HCV RNA between January 2001 and January 2002 and either acute hepatitis, a seroconversion for HCV antibodies, or a previous negative result. Three control-patients were randomly selected per case-patient.

RESULTS: Of the 61 patients treated in the unit in 2001 and not infected with HCV, 22 (36.1%) became case-patients with onset from May 2001 to January 2002 for an incidence density rate of 70 per 100 patient-years. Phylogenic analysis identified four distinct HCV groups and an index case-patient for each with a similar virus among patients already known to be infected. No multidose medication vials or material was shared between patients. Connection to a dialysis machine by a nurse who had connected an HCV-infected patient "just before" or "one patient before" increased the risk of HCV infection, whereas using the same dialysis machine after a patient infected with HCV did not. Understaffing, lack of training, and breaches in infection control were documented. Direct observation of practices revealed frequent flooding of blood into the double filter on the arterial pressure tubing set.

CONCLUSIONS: During this outbreak, HCV transmission was mainly patient to patient via healthcare workers' hands. However, transmission via dialysis machines because of possible contamination of internal components could not be excluded.

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化生

为什么全是英文的，我不懂。

天时说爱你

英语水平差确实需要提高。很费劲。

紫陌红尘

天时说爱你 发表于 2013-3-15 11:15

                               
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英语水平差确实需要提高。很费劲。

全文的主要结论本来已经写在每篇的结尾处了。。。现在我重新修改一下，中文主要结论放在前头，原文放后面，希望有利于大家查看。

safihu

紫陌红尘 发表于 2013-3-15 11:21

                               
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全文的主要结论本来已经写在每篇的结尾处了。。。现在我重新修改一下，中文主要结论放在前头，原 ...

HCV与HBV不同，丙肝患者血中的HCV滴度低，而且HCV体外室温下迅速降解。因此，美国CDC认为对血透患者按照规范进行感染控制，不会传播HCV，甚至并不推荐对HCV感染的患者象HBV感染一样进行隔离，只需常规检测ALT和HCV即可。

美国CDC还是比较循证啊，一直都是这样建议的。而我们的很多规范都是专家认为应该隔离那就隔起来，原理和依据呢，不知道。