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The Purpose of this policy is to ensure that the WRTU within the Trust offers a unified and inter-professional approach towards the management and prevention of Hepatitis B for all clients in accordance with Department of Health guidelines.

Extracts from this document...

Introduction

CONTENTS LIST: 1. INTRODUCTION 2. POLICY STATEMENT 3. DEFINITION 4. PROTOCOL 5. SHARED CARE PROTOCOL FOR HEPATITIS B VACCINATION 6. HEPATITIS B VACCINATION STRATEGY * Pre-Vaccination screening protocol * Post-Vaccination screening protocol 7. LETTER TO GP EXPLAINING SHARED-CARE PROTOCOL FOR IMMUNISATION 8. LETTER TO PATIENTS EXPLAINING VACCINATION RECOMMENDATION 9. CURENT POLICY FOR SCREENING FOR HEPATITIS B 10. MANAGEMENT OF PATIENTS WITH HEPATITIS B ON HAEMODIALYSIS 11. REFERENCES 1: INTRODUCTION Viral Hepatitis was recognised as a potential hazard for dialysis patients and staff in the 1960's following several outbreaks of the infection. Serum hepatitis now known as hepatitis B and is caused by the hepatitis B virus (HBV) was found to be responsible for several deaths. In 1970 the Health Department set up a group led by Lord Rosenheim to review problems of hepatitis and make recommendations. In 1972 the Rosenheim report was published and a set of guidelines issued for the prevention and control of HBV in renal dialysis/Transplantation Units. These guidelines which include universal barrier precautions about exposure to blood, regular screening of patients and staff for infection and segregation of infected patients have formed the basis for the safe practise of dialysis throughout the country (DOH 2003). ...read more.

Middle

If less than 10IU/ml test for core antibody to exclude past/current infection. * If levels are undetectable, discuss on a case per case basis with the virology department before administering additional doses of vaccine * To measure immune response. * Unless there is documented evidence of having had the full course of high dose vaccine Non-responders should be given a full course of HBVAX PRO 40 If vaccinated with a full course more than 5 years ago: * Arrange for a single dose of HB-Vax II 40 to be administered via GP. * Check surface antibody level one month post administration. If less than 10IU/ml test for core antibody to exclude past/current infection. * A single dose will act as a booster if previous vaccination has established immunity * Course of vaccine can be completed if single booster does not produce a surface antibody level of >100mIU/ml If vaccinated but doubtful about completion of course: * Arrange for a single dose of HB-Vax II 40 to be administered via GP. * Check surface antibody level one month post administration. If less than 10IU/ml test for core antibody to exclude past/current infection * A single dose will act as a booster if previous vaccination has established immunity. ...read more.

Conclusion

If you have any further queries, please do not hesitate to contact one of the nurses in the relevant clinical area given above, for information. Contact numbers are provided on the enclosed shared-cared protocol. Yours sincerely Dr R Lewis Clinical Director WRTU Consultant Nephrologist 9: Current Policy for Screening for Hepatitis B * Patients admitted to a Renal Unit should be routinely tested for HbsAg unless they have been tested one month prior to admission * All patients must have a known hepatitis B status prior to commencement on haemodialysis treatment * Patients re-admitted following dialysis outside United Kingdom should be tested and found negative for HbsAg before being dialysed in the main unit. Individual risk assessment should be taken for patients who dialysed in countries where exposure to HBV is considered likely * Patients on chronic haemodialysis programme are routinely tested every three months for HBsAg 10: Management of patients with Hepatitis B virus on haemodialysis * Patients infected with HBV should ideally be dialysed in separate isolation facilities * Separate machines should be used for patients with HBV * Rigorous application of universal precautions is essential to prevent blood contamination and transmission of infection. * All equipment to be cleaned and disinfected as per unit protocol. * Disposal of waste as per infection control guidelines 11. ...read more.

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