Control of hepatitis B infection. The role of surveillance and an isolation hemodialysis center

G. R. Najem, D. B. Louria, I. S. Thind, M. A. Lavenhar, D. J. Gocke, S. E. Baskin, A. M. Miller, H. J. Frankel, J. Notkin, M. G. Jacobs and B. Weiner

A 3 1/4-year study assessed intervention approaches for hemodialysis-associated hepatitis. A 12-month retrospective study was followed by one year of prospective surveillance (during which attention to hygienic techniques was encouraged) and then by a 15-month period during which antigen-positive cases were transferred from study centers to an isolation hemodialysis center (IHL). The incidence of hepatitis B infection (HBI) fell 35.9% in study centers during surveillance; this was followed by a 50.0% drop during the IHC phase. The total 67.9% drop during the entire study period was statistically highly significant; the IHC contributed significantly more to the total drop than did surveillance alone. At comparison units, HBI increased 97.9% during the same period. This study indicates that HBI incidence can be markedly reduced by a combination of surveillance and assignment of antigen-positive patients to a separate dialysis unit.