Froio Nicola, Nicastri Emanuele, Comandini Ubaldo Visco, Cherubini Chiara, Felicioni Roberto, Solmone Mariacarmela, Di Giulio Salvatore, Petrosillo Nicola
National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy.
Am J Kidney Dis. 2003 Sep;42(3):546-50. doi: 10.1016/s0272-6386(03)00787-x.
Hepatitis virus infections continue to be a major concern in the dialysis setting. We studied levels of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) RNA contamination in dialysis units to better define the role of the dialysis environment and machines in the nosocomial transmission of hepatitis viruses.
Possible contamination by hepatitis B virus (HBV) and HCV was studied by collecting environmental samples in 3 dialysis units located in Rome, Italy. Samples and controls were tested for HBsAg by a microparticle enzyme immunoassay, and for HCV RNA, by qualitative transcription-mediated amplification assay.
HCV RNA and HBsAg were detected in 1 of 64 (1.6%) and 1 of 64 samples (1.6%), respectively. The only HCV RNA-positive sample was found in 1 dialysis unit on the external surface of the dialysate (inlet-outlet) connector of a dialysis machine used for HCV-negative patients. The only HBsAg-positive sample was found in another dialysis unit on the internal surface of the blood pressure monitor cuff of a dialysis bed dedicated for HBsAg-positive patients.
A segregation policy for HBsAg-positive patients is a necessary measure despite its high cost-effectiveness; we found HBsAg contamination in the segregated HBV-infected room. Conversely, the finding of HCV RNA contamination on a dialysis machine not dedicated to HCV-positive patients suggests that isolation of HCV-infected dialysis patients and use of dedicated machines are unjustified. Major attention should be given to strict adherence to infection control measures in the dialysis setting.
在透析环境中，肝炎病毒感染仍然是一个主要问题。我们研究了透析单元中乙型肝炎表面抗原（HBsAg）和丙型肝炎病毒（HCV）RNA的污染水平，以更好地确定透析环境和机器在肝炎病毒医院内传播中的作用。
通过在意大利罗马的3个透析单元采集环境样本，研究乙型肝炎病毒（HBV）和HCV的可能污染情况。样本和对照通过微粒酶免疫测定法检测HBsAg，通过定性转录介导扩增测定法检测HCV RNA。
在64个样本中的1个（1.6%）检测到HCV RNA，在64个样本中的1个（1.6%）检测到HBsAg。唯一的HCV RNA阳性样本是在一个用于HCV阴性患者的透析机的透析液（进出口）连接器外表面的1个透析单元中发现的。唯一的HBsAg阳性样本是在另一个透析单元中，在一张专门用于HBsAg阳性患者的透析床的血压监测袖带内表面发现的。
尽管HBsAg阳性患者的隔离政策成本效益高，但仍是一项必要措施；我们在隔离的HBV感染病房中发现了HBsAg污染。相反，在一台并非专门用于HCV阳性患者的透析机上发现HCV RNA污染表明，隔离HCV感染的透析患者并使用专用机器是不合理的。应高度重视在透析环境中严格遵守感染控制措施。
