الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hemodialysis (HD) is one of the main modalities of renal replacement therapy. Maintenance of dialysis with its extracorporeal circulation of blood provides increased risk of transmission of blood- borne infective agents mainly HBV and HCV.
The prevalence of HBV is highest in Africa and Middle East, where 6.1% and 3.3% of populations are infected respectively. The prevalence of HBV in Egypt was 1.4% in general population, while it is 16.9% in HD patients. HCV constitutes an epidemic in Egypt having the highest prevalence in the world, about 14.7% of general population and up to 41.97% in HD patients are HCV seropositive.
The diagnosis of HBV is by detecting HBs Ag in plasma or serum by ELISA test. Anti- HBc can be considered a sentinel marker of exposure to HBV infection. Anti- HBc alone (without HBs Ag & HBs Ab) is a possible marker of occult HBV.
Anti- HCV persist indefinitely in patients who develop chronic HCV infection. ELISA test detect Ig G antibodies against several HCV antigens, its third generation has higher sensitivity and specificity, the window period has been decreased to 8 weeks by it. Confirmation of serological reactive tests can be done by nucleic acid amplification (NAT).
The prevention of HBV and HCV in hemodialysis as recommended by CDC included: Hand washing after touching blood or body fluids, use of gowns and face shields where exposure is anticipated, decontamination of equipments (including dialysis machines) and environmental surfaces, no reuse of dialyzers, isolation of HBV carriers, isolation of HCV patients whenever there is high nosocomial transmission, and active HBV vaccination of patients and healthcare workers.
The present study aimed to evaluate HBV and HCV seroconversion among hemodialysis patients in 2 hemodialysis units in Alexandria by detecting HBsAg, anti HBc and HCV- Ab in HD patients. Also to identify the risk factors associated with HBV and HCV seroconversion in these HD units.
A prospective study was conducted on 110 seronegative patients on HD: 67 (60.91%) attending Alexandria Fever Hospital and 43 (30.09%) attending Ras El Teen Hospital, Alexandria, over a period of 6 months in 2018. Blood samples (3 ml each) were taken from those patients to be screened by ELISA for anti HBc, HBsAg and anti HCV as follows:
•Month 0: Anti-HBc, HBs Ag and anti –HCV
•Month 3: HBs Ag and anti –HCV
•Month 6: HBs Ag and anti –HCV
The results of the present study revealed that:
For all patients in both hospitals, the frequency of dialysis was three times per week and the duration of each dialysis session was 4 hours. All healthcare workers and HD patients included in this study had received HBV vaccine. None of the included patients had history of bilharzial infecti
Summary, Conclusion and Recommendationson. Thirty two (29.09%) patients attending both hospitals were anti-HBc positive. The HD duration of anti- HBc positive and negative patients in both units ranged from 5- 9 years and 1- 4 years, respectively. All 110 HD (100.0%) patients were negative for HBs Ag and HCV Ab at zero, three and six months.
All healthcare workers inspected during the study complied with assigned infection control measures regarding: injectable medication administration, catheter connection and disconnection, arteriovenous fistula/graft cannulation, routine disinfection of environmental surfaces, HD machine and blood lines.
It can be concluded from the present study that:
1-No HBV or HCV seroconversion was detected among the studied HD patients. 2- Infection control measures were strictly adopted in studied HD units.