The impact of nurse understaffing on the transmission of hepatitis C virus in a hospital-based hemodialysis unit.

OBJECTIVE To determine the impact of nurse understaffing on the transmission of hepatitis C virus (HCV) infection in a large hospital-based hemodialysis (HD) unit with a high HCV prevalence. SUBJECTS AND METHODS The records of 198 patients (107 males and 91 females) with end-stage renal disease enrolled on long-term HD at King Fahad Hospital and Tertiary Care Center, Hofuf, Saudi Arabia, from August 1995 to August 2000, were retrospectively reviewed. The patients were assigned to HD groups of varying patient-to-nurse (P/N) ratios: group I, 2:1; group II, 3:1, and group III, 4:1. HCV prevalence, seroconversion rates, history of blood transfusion and dialysis age (time span since the initiation of the HD treatment) were recorded and compared. RESULTS The overall HCV prevalence and seroconversion rate per year were 43.4 and 8.6%, respectively. Group I had the lowest HCV prevalence and annual seroconversion rate (26.8%; 5.3%), followed by group II (43.6%; 8.7%); group III had the highest HCV prevalence and seroconversion rate (71.8%; 14.4%). Anti-HCV positivity was associated with a higher dialysis age. CONCLUSION The finding that the patients in the groups with the relatively higher P/N ratio had the significantly higher HCV prevalence and seroconversion rates per year indicates that understaffing is likely to play a major role in the transmission of HCV in HD units, and we suggest that improved staffing may be helpful in reducing the HCV transmission in such dialysis units.