Low risk for hepatitis B exposure in Virginia Mason dialysis unit

Today, Virginia Mason Medical Center notified the public about a lapse in recommended hepatitis B screening and isolation procedures for patients who had received care in their dialysis unit. Public Health – Seattle & King County conducted an investigation into the risk to patients and staff at Virginia Mason. We asked Dr. Jeff Duchin, Health Officer and Chief of Communicable Disease Epidemiology and Immunizations, about what they learned from that investigation and what patients should know.

First of all, what happened at Virginia Mason that prompted the investigation?

Dr. Jeff Duchin, Health Officer at Public Health – Seattle & King County, joins Dr. Bonnie Collins of Northwest Kidney Centers and Dr. Cyrus Cryst of Virginia Mason at a media briefing.

JD: In late May, Virginia Mason notified us that they became aware that staff had not been consistently screening dialysis patients for hepatitis B infection as recommended by the Centers for Disease Control and Prevention. If a dialysis patient is identified as having hepatitis B, they receive their treatment in a private room, isolated from other patients. This screening and isolation is recommended as one of multiple steps to prevent transmission of hepatitis B during dialysis.

What did you do in your investigation?

Our staff analyzed dialysis protocols and interviewed infection control staff at Virginia Mason and also dialysis staff from the Northwest Kidney Center, who are contracted to provide dialysis at Virginia Mason. We took a thorough look at how equipment is cleaned and sterilized, who provides the care and what precautions they take, and screening and isolation protocols.  And we consulted with experts at the Centers for Disease Control and Prevention regarding the incident.

Why did you determine that the risk is the low?

Our investigation showed that although routine screening and isolation of hepatitis B positive patients wasn’t happening, all the other recommended steps to prevent infections were being followed appropriately, including disinfection and cleaning, standard infection control precautions, and use of appropriate personal protective equipment by hospital staff. We did not find any evidence of increased of risk for acquiring blood borne pathogen infections in the dialysis unit. Everything that Virginia Mason was doing for infection control should be sufficient to prevent transmission of hepatitis B as well as other blood borne viruses.

Chronic hepatitis B is also a relatively rare disease. The overall prevalence of hepatitis B in the U.S. population is 0.3%. That fact, in addition to the infection control measures in place, led to our assessment that the risk of transmission of hepatitis B in this situation is very low.

If the risk is so low, why was it necessary to notify the patients and the public?

We agree with Virginia Mason’s decision to notify patients and the public in the interest of transparency. In addition,  some patients may still need to get the recommended hepatitis B blood testing to be sure of their hepatitis B status.  But most chronic kidney dialysis patients are regularly screened for hepatitis B infection by their outpatient dialysis providers as part of their routine care and will not need to take any special action in response to this incident.

If patients who received treatment for dialysis at Virginia Mason, what should they do?

They should contact their health care provider or chronic dialysis provider to determine their hepatitis B status or need for further screening. We also recommend that patients who haven’t yet been vaccinated for hepatitis B (and haven’t been infected in the past) get a vaccination. Virginia Mason has a call line at 1-877-255-3793 to speak with a medical expert at Virginia Mason.

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I am a risk communications specialist at Public Health - Seattle & King County.