All Listed Options ARE Recommended Practices for HCV Control in Dialysis
All three options (A, B, and C) are explicitly recommended infection control measures for preventing hepatitis C transmission in dialysis clinics, making "D. All of the above" the correct answer to this EXCEPT question.
Standard Infection Control Practices (Options A & B)
The KDIGO 2022 guidelines strongly recommend that hemodialysis facilities adhere to standard infection control procedures to prevent transmission of blood-borne pathogens 1. These specifically include:
- Proper hand hygiene and glove changes, especially between patient contacts, before invasive procedures, and after contact with blood and potentially blood-contaminated surfaces 1
- Thorough cleaning and disinfection of surfaces at the dialysis station, particularly high-touch surfaces 1
- Proper injectable medication preparation following aseptic techniques 1
- Adequate separation of clean supplies from contaminated materials 1
Multiple HCV outbreaks in hemodialysis centers have been traced to deficiencies in these infection control practices, including lapses in hand hygiene, glove use, injectable medication handling, and environmental surface disinfection 1. Regular observational audits of infection control procedures are recommended to ensure adherence 1.
Routine Serologic Testing and Surveillance (Option C)
Systematic HCV surveillance is a cornerstone of infection control in dialysis units 1:
- Screen all patients upon initiation of in-center hemodialysis or transfer from another facility using immunoassay or nucleic acid testing (NAT) (Grade 1A recommendation) 1
- Continue screening every 6 months for all in-center hemodialysis patients using immunoassay or NAT (Grade 1B recommendation) 1, 2
- Hemodialysis centers must examine and track all HCV test results to identify new cases of infection (Grade 1B recommendation) 1
When a new HCV infection is identified, aggressive measures must be taken immediately 1:
- Test all patients in the facility for HCV infection (Grade 1A) 1, 2
- Increase testing frequency temporarily (monthly for 3 months, then at 6 months) 2
- Conduct detailed review of infection control practices 1
- Report seroconversion to public health authorities 1
What Is NOT Recommended
Notably, the guidelines explicitly recommend against certain practices that were historically used 1:
- Do NOT use dedicated dialysis machines for HCV-infected patients (Grade 1D recommendation) 1
- Do NOT isolate HCV-infected patients during hemodialysis sessions (Grade 2C recommendation) 1
These practices are not recommended because there is no evidence of HCV transmission through internal pathways of single-pass dialysis machines, and isolation does not improve outcomes when standard infection control procedures are properly followed 1.
Clinical Pitfall
The critical error in dialysis units is prioritizing patient isolation or dedicated machines over rigorous adherence to standard infection control practices 1. The KDIGO guidelines explicitly state that strategies to prevent HCV transmission should prioritize adherence to standard infection control practices and should not primarily rely upon treatment of HCV-infected patients 1.