Virginia Mason notifies 650 dialysis patients about hepatitis B exposure

Virginia Mason sent letters to 650 patients who were treated in the medical center’s dialysis unit because they may have been near a hepatitis B-positive patient.

Here's why patients were notified 

In a news release, Virginia Mason writes that it is notifying patients out of an abundance of caution because it believes the exposure risk is “very low.”

Virginia Mason says that some guidelines for isolating patients were not consistently followed because of the unknown hepatitis status of some patients.

The medical center says that a Public Health -- Seattle and King County assessment shows that its dialysis infection control practices were appropriate for the prevention of hepatitis B transmission. These practices include cleaning and disinfection of the machines and the environment, use of personal protective equipment and appropriate hand hygiene.

What you should do if you had dialysis treatment 

However, it does recommend that anyone who had hemodialysis in the last five years should contact his or her health care provider. Anyone with questions can contact Virginia Mason with questions or concerns at 1-877-255-3793.

"If you are a regular dialysis patient, your dialysis unit is likely routinely testing you for hepatitis B according to guidelines. Check with your dialysis provider to be sure you have been tested. If you are immune to hepatitis B, there is nothing more to do with respect to this notice," Nephrology Section head Cyrus Cryst wrote in a letter.

Q&A from Virginia Mason

Virginia Mason wrote a questions-and-anwsers sheet for patients. It is designed to address questions associated with our processes. If you are a patient and have questions that are not answered here, contact the Nephrology team at 1-877-255-3793.

1. What is the issue with dialysis unit screening?
Virginia Mason discovered in mid-May we had been inconsistent in screening all dialysis patients for hepatitis B on admission and every 30 days. As a result, not every hepatitis B-positive patient was appropriately isolated during dialysis at Virginia Mason. The risk that other patients were exposed to hepatitis B was very low because of other infection-control safeguards and the limited ways the virus can spread from person to person. Out of an abundance of caution, we are contacting patients to inform them they may have been near a hepatitis B-positive patient in the dialysis unit.

2. Why weren't you isolating hepatitis B-positive patients?
Because our screening process was not consistent, we were not always aware of the current hepatitis B status of all patients treated in our dialysis unit.

3. What have you done to correct the situation?
We worked collaboratively with Northwest Kidney Centers, which provides dialysis services at Virginia Mason, to immediately correct our process. Specifically, we have added a feature to the electronic medical record that now automatically orders a hepatitis B screening for dialysis patients. This step ensures each patient's hepatitis B status is current. It also alerts the care team to appropriately isolate an individual who is hepatitis B-positive during dialysis.

4. What does "appropriately isolated" mean?
Hepatitis B-positive patients receive dialysis in a private room, outside the communal environment of the dialysis unit that accommodates three patients at a time.

5. Why do you believe the exposure and transmission risk was low?
An assessment by Public Health – Seattle & King County indicated our general infection control practices were adequate to prevent hepatitis B transmission. In addition, they believe the risk for hepatitis B transmission in Virginia Mason's dialysis unit to be very low. There are numerous infection-control safeguards in our dialysis unit. For example:

• All dialysis staff are vaccinated against hepatitis B and wear clothing that protects patients and team members.
• Our dialysis machines are cleaned according to manufacturer guidelines.
• As for transmission, hepatitis B is spread when blood or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. Given our many precautions, this is unlikely to happen in our dialysis unit.

6. How did you discover hepatitis B-positive patients were not always appropriately isolated in your dialysis unit?
The situation was discovered during a quality assessment of our processes.

7. How large is the dialysis unit at Virginia Mason?
Our dialysis unit accommodates three dialysis patients at a time. In 2014, we provided about 1,500 treatments for 262 patients in the dialysis unit.

Additional Resources:

• Hepatitis B information from the Centers for Disease Control and Prevention
• Public Health – Seattle & King Countyy

Cox Media Group