Wreghitt T G
Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.
Rev Med Virol. 1999 Apr-Jun;9(2):101-9. doi: 10.1002/(sici)1099-1654(199904/06)9:2<101::aid-rmv234>3.0.co;2-u.
Hepatitis outbreaks in haemodialysis unit patients and staff were reported in the late 1960s. In 1972, the Rosenheim report in the UK established guidelines which included routine tests for hepatitis B surface antigen and isolation facilities for dialysing patients with hepatitis B virus which resulted in a dramatic fall in cases of hepatitis. However, since these guidelines were introduced, other blood-borne viruses, notably HCV and HIV have been discovered, and failures of infection control practices still lead to outbreaks of HBV in haemodialysis units. The prevalence of HCV in dialysis patients varies considerably throughout the world, with reported prevalence ranging from 3.9% to 71%. The number of blood transfusions and the length of time on dialysis have consistently been associated with HCV prevalence. Several reports provide evidence of patient-to-patient HCV transmission with environmental blood contamination the most significant factor in intra-unit transmission. There is no evidence that HCV has been transmitted by re-use of dialysis machines but being dialysed next to an HCV positive patient is associated with a significant risk of HCV acquisition. Several studies have shown that dialysing HCV positive patients in a separate unit or in a defined sector of a dialysis unit significantly reduces nosocomial HCV infection. HGV is prevalent in dialysis units where there is evidence of transmission to patients but no evidence of associated symptoms. HIV is infrequently transmitted in dialysis units and several units treating many HIV-positive patients have shown no evidence of transmission. Careful attention needs to be paid to infection control procedures and regular virological testing.
20世纪60年代末报告了血液透析单位患者和工作人员中发生的肝炎暴发。1972年，英国的罗森海姆报告制定了指导方针，其中包括对乙型肝炎表面抗原进行常规检测以及为感染乙型肝炎病毒的透析患者设立隔离设施，这导致肝炎病例大幅下降。然而，自引入这些指导方针以来，又发现了其他血源性病原体，尤其是丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV），而且感染控制措施的失误仍会导致血液透析单位发生乙型肝炎病毒暴发。世界各地透析患者中HCV的流行率差异很大，报告的流行率从3.9%到71%不等。输血次数和透析时间长短一直与HCV流行率相关。几份报告提供了患者之间HCV传播的证据，环境血液污染是单位内传播的最重要因素。没有证据表明HCV是通过重复使用透析机传播的，但在HCV阳性患者旁边进行透析会有感染HCV的显著风险。几项研究表明，在单独的单位或透析单位的特定区域为HCV阳性患者进行透析可显著降低医院内HCV感染。庚型肝炎病毒（HGV）在透析单位中普遍存在，有证据表明其可传播给患者，但没有相关症状的证据。HIV在透析单位中很少传播，几个治疗许多HIV阳性患者的单位没有传播证据。需要密切关注感染控制程序和定期进行病毒学检测。
