Fabrizi Fabrizio, Martin Paul, Messa Piergiorgio
G Ital Nefrol. 2013 Jul-Aug;30(4).
Infections with blood-borne pathogens are still common among patients on maintenance dialysis all over the world. The control of infection due to blood-borne viruses (particularly HBV) within dialysis units has been a major goal in the management of patients with chronic kidney disease in the industrialized world. Standard precautions and specific procedures have been recommended to prevent infections with HBV, HCV and HIV within dialysis units. Isolation of HBsAg positive patients by dialysis rooms, staff and machines continues to be an important step to control HBV infection within dialysis units, according to the CDC and other regulatory agencies. Some prospective observational studies have reported the complete prevention of HCV transmission to hemodialysis patients in the absence of any isolation policy, and the use of dedicated dialysis machines for HCV-infected patients is not recommended by clinical guidelines. Isolation of HCV-infected patients should be considered in special circumstances only. Vaccination is an important tool against transmission of HBV among patients on long-term dialysis even if the immune response towards the hepatitis B vaccine remains unsatisfactory. Hemodialysis is considered a low risk setting for the transmission of human immunodeficiency virus (HIV) infection, providing that standard and specific procedures are carefully observed. HIV-infected patients do not have to be isolated from other patients or dialyzed separately on dedicated machines.
在全球范围内，维持性透析患者中血源性病原体感染仍然很常见。在工业化国家，控制透析单位内血源病毒（尤其是乙肝病毒）感染一直是慢性肾脏病患者管理的主要目标。已推荐采取标准预防措施和特定程序以防止透析单位内乙肝病毒、丙肝病毒和艾滋病毒感染。根据美国疾病控制与预防中心（CDC）和其他监管机构的建议，通过透析室、工作人员和机器对乙肝表面抗原（HBsAg）阳性患者进行隔离，仍然是控制透析单位内乙肝病毒感染的重要措施。一些前瞻性观察性研究报告称，在没有任何隔离政策的情况下，完全可以预防丙肝病毒传播给血液透析患者，临床指南也不建议为丙肝感染患者使用专用透析机。仅在特殊情况下才应考虑对丙肝感染患者进行隔离。疫苗接种是预防长期透析患者中乙肝病毒传播的重要手段，即便对乙肝疫苗的免疫反应仍不尽人意。只要严格遵守标准和特定程序，血液透析被认为是人类免疫缺陷病毒（HIV）感染传播的低风险环境。HIV感染患者无需与其他患者隔离，也不必在专用机器上单独进行透析。
