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Saotharlann Náisiúnta Tagartha Viris UCD

Blood Borne Virus Prevention. Dr. Jeff Connell Assistant Director, NVRL 3 rd Annual Transplant and Nephrology Conference November 28 th 2014. Saotharlann Náisiúnta Tagartha Viris UCD. UCD National Virus Reference Laboratory. Blood Borne Virus Prevention. Background

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Saotharlann Náisiúnta Tagartha Viris UCD

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  1. Blood Borne Virus Prevention Dr. Jeff Connell Assistant Director, NVRL 3rd Annual Transplant and Nephrology Conference November 28th 2014 Saotharlann Náisiúnta Tagartha Viris UCD UCD National Virus ReferenceLaboratory

  2. Blood Borne Virus Prevention • Background • Review of guidelines and protocols to prevent blood-borne infection in renal dialysis patients – in particular the 2013 version. • HCV • HBV • HIV

  3. Prevention of BBV infection in dialysis units

  4. Prevention of BBV infection in dialysis units

  5. Blood Borne Virus Prevention – diagnostic challenges BBV Diagnostic investigation

  6. Infection time course – diagnostic challenges ?

  7. Blood borne screening

  8. Prevention of blood borne-virus transmission 2005 2008

  9. Problem with the guidelines Prevention of blood borne-virus transmission 2005 • Significant problems associated with quarantine of dialysis machines and isolating Blood borne infected patients • Major issues with HCV screening

  10. HCV

  11. HCV infection in Dialysis patients

  12. Significant changes to the guidelines Prevention of blood borne-virus transmission 2010

  13. Prevention of HCV infection – Laboratory investigation Availability of the HCV Ag assay

  14. Third generation antibody test First generation antibody test 0 10 20 30 40 50 60 70 80 90 100 HCV Antigen HCV RNA/Ag Second generation antibody test Laboratory Investigation of HCV HCV RNA HCV Ag HCV Ab Cutting the “window period”

  15. Prevention of HCV infection – Laboratory investigation Availability of the HCV Ag assay

  16. Prevention of HCV infection – HCV negative

  17. Prevention of HCV infection – HCV Infected patient Attempted to cohort based upon HCV viral load level

  18. Prevention of blood borne-virus transmission

  19. Guidelines 2013 – why change the guidelines

  20. HCV treatment - summary

  21. Guidelines 2013

  22. Guidelines 2013

  23. Guidelines 2013 – HCV treatment

  24. HBV

  25. Guidelines 2013- HBV

  26. Guidelines 2013

  27. Management of HBV infected patients on dialysis

  28. Post-hepatitis B vaccination

  29. Hepatitis B vaccination Weak positive result s can be observed in HBsAg tests if a blood sample is collected immediately after HBV vaccination. Therefore HD patients should be tested for HBsAg for at least 7 days after HBV vaccination

  30. Summary of laboratory Investigation of HBV

  31. HIV

  32. HIV infection in dialysis units • Failure of Infection prevention and control • Multi-dose heparin vial shared by all 3 HIV infected patients • Inadequately disinfected equipment • Dialysis staff used blood contaminated gloves to manipulate vascular access for multiple patients • Index patient: HIV screening prior to dialysis – 1st sample unsuitable, Rapid HIV test result indeterminate

  33. Prevention of HIV infection – Laboratory investigation

  34. Prevention of HIV infection – Laboratory investigation

  35. Management of HIV infected patients on dialysis

  36. Post transplant BBV

  37. Anti-viral immunity post transplant

  38. Renal transplant patients - ? Role for 3 months “sign off” testing

  39. Blood Borne Virus Prevention Thank you for your attention Questions ? Saotharlann Náisiúnta Tagartha Viris UCD UCD National Virus ReferenceLaboratory

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