Fabrizi Fabrizio, Dixit Vivek, Messa Piergiorgio, Martin Paul
1 Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milan - Italy.
Int J Artif Organs. 2015 Jan;38(1):1-7. doi: 10.5301/ijao.5000376. Epub 2015 Jan 26.
Changes in the delivery of healthcare in the developed world have resulted in frequent reporting of outbreaks of hepatitis B virus (HBV) infection in nonhospital healthcare settings, including hemodialysis units.
We performed a systematic review of HBV outbreaks in dialysis units of developed and less-developed countries published between 1992 and 2014 to elucidate the most frequent mechanisms of patient-to-patient transmission of HBV in this setting.
The research was performed using the PubMed Database and the Outbreak Database; studies were selected according to the PRISMA algorithm. Inclusion criteria were established before the papers were retrieved in order to avoid selection biases.
12 papers reported on 16 outbreaks that involved 118 patients on maintenance dialysis; 10 fatal cases occurred. European outbreaks were smaller compared with the others (P = 0.0046). Information on specific transmission pathways was given in many outbreaks (n = 10; 62%); multiple deficiencies in standard or hemodialysis-specific procedures was the most common route of patient-to-patient transmission of HBV (80%, 8/10). De novo HBV from HBsAg negative/HBV DNA positive blood donors was found in 2 (20%) oubreaks. Sharing of contaminated HD machines was mentioned in 1 report.
Our systematic review of HBV outbreaks shows that incomplete adherence to standard and dialysis-specific infection control precautions was the most important cause of patient-to-patient transmission of HBV in dialysis units. This review should serve as a reminder to HD providers that the risk of HBV infection is still present among patients undergoing dialysis and that HBV may be easily transmitted in the dialysis setting whenever appropriate infection control practices are not strictly applied.
发达国家医疗保健服务的变化导致非医院医疗环境中，包括血液透析单位，频繁报告乙型肝炎病毒（HBV）感染暴发。
我们对1992年至2014年间发表的有关发达国家和欠发达国家透析单位HBV暴发的研究进行了系统评价，以阐明在此环境下患者间HBV传播最常见的机制。
使用PubMed数据库和暴发数据库进行研究；根据PRISMA算法选择研究。在检索论文之前确定纳入标准，以避免选择偏倚。
12篇论文报告了16起暴发事件，涉及118例维持性透析患者；发生了10例死亡病例。与其他地区相比，欧洲的暴发规模较小（P = 0.0046）。许多暴发事件（n = 10；62%）提供了关于具体传播途径的信息；标准或血液透析特定程序的多重缺陷是HBV患者间传播最常见的途径（80%，8/10）。在2起（20%）暴发事件中发现了来自HBsAg阴性/HBV DNA阳性献血者的新发HBV。1份报告中提到了共用受污染的血液透析机。
我们对HBV暴发的系统评价表明，不完全遵守标准和透析特定的感染控制预防措施是透析单位中HBV患者间传播的最重要原因。本评价应提醒血液透析服务提供者，接受透析的患者中仍存在HBV感染风险，并且只要不严格应用适当的感染控制措施，HBV在透析环境中可能很容易传播。
