PREVALENCE OF HEPATITIS B AND C VIRUS AMONG HEMODIALYSIS PATIENTS AND INFECTION CONTROL IN DIALYSIS UNITS IN SANA'A CITY, YEMEN

Abstract

Background of the study: Patients on hemodialysis are at high risk of viral hepatitis B and C due to high number of blood transfusion sessions, prolonged vascular access, and high exposure to infected patients and contaminated equipment, or cross contamination from the dialysis circuits. Objective of the study: The objective of this study was to investigate the prevalence of HBV & HCV among hemodialysis patients and infection control in dialysis units in Sana,a City, Yemen Research Methodology: A descriptive cross-sectional study of 349 patients with HD and 58 staff nurses working in the HD units in three hospitals in Sana'a city, Yemen. A stratified random sampling method was administered to select 349 hemodialysis patients. Data were collected through self-administered questionnaire and retrospectively from patients' files from 1 May to 30 July 2018. The questionnaire was includes Part 1: the demographic data of the patients, medical history of patients (Frequency of HD sessions, duration of dialysis and history of HBV vaccination) and history of HBV&HCV infection among patients: at screening stage and at follow-up stage which includes. Socio-demographic characteristics of staff nurses and history of HBV vaccination were also collected. Part 2: Principles of infection prevention and control in dialysis unit. A pilot study was conducted and validity and reliability of the questionnaire was also tested. The data were analyzed using SPSS and measured using frequency and percent for categorical variables and Means and SD for quantitative variable. Student’s t-test, χ2 test and McNamee test were used. Spearman Coefficient and Phi correlation were used to measure correlation between variable. Cronbach’s Alpha Coefficient and Spearman–Brown Coefficient were used to test reliability of questionnaire. A P-value ≤ 0.05 (2-tailed) was considered statistically significant. Approval from Al-Razi University was obtain. Oral consent was obtained from patients and nurses to participate in the study. Results: A total of 349 patients undergoing hemodialysis, aged 13 to 85 years with Mean±SD was 31.9±7.3 and 59.3% were males. Most of the patients undergo two HD sessions per week (93.4%). As regards to duration of hemodialysis (69.1%) of the patients the duration of HD was less than 6 years. The overall prevalence of positive HBsAg among HD patients was found to be 2.9% before HD and 14.3% during HD at follow-up stage while positive anti-HCV was 2% before HD and 17.2% during HD at follow-up stage and (5) cases was mixed infection with HBV and HCV. A statistically significant differences in prevalence of HBV was found by HD units (p-value <0.05). No statistically association in prevalence of HBV and HCV by patents demographic data (p-value>0.05). A statistically correlation between the prevalence of HBV and HCV by frequency of HD sessions was not observed (p-value>0.05). The study found a strong correlation between prevalence of HBV and HD duration (p-value=0.000). On the other hand, a strong correlation was found between prevalence of HCV and duration of HD (p-value=0.000). Out of 58 staff nurses the age mean and SD was 31.5±7.3. 56.9% of the nurses were male. A total responses 64.8% of the staff nurses did not applied screening, immunization and routine testing in dialysis units, 51.2% were practiced standard and transmission-based precaution, 41.8% were practiced environmental, cleaning and disinfection, 61.4% were cleaned and disinfected equipment and 60.7% of the nurses were practiced safe medication in all HD units. 64.6% of the nurses were not familiar with these policies and program in all HD units. 56.9% of the nurses were not tested and treated water of HD machine in all HD units. Conclusion and Recommendations: The study concluded that, the prevalence of HBV and HCV infection in patients who received HD 14.3% for HBV was and 17.2% for HCV. The study recommended that, in each HD unit, policies and practices should be applied.