الفهرس 
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Abstract
Hepatitis C virus infection has recently become the major cause of chronic liver disease among patients on chronic HD who are at high risk of infection by HCV. Risk factors as dialytic age, blood transfusion and possibility of nosocomial HCV transmission have been suggested.
Preventing HCV infection, the most important public health issue in HD units in Egypt. This means stopping or reducing the transmission of HCV from an infected person to a person who is not infected.
The aim of this study was to determine the risk factors of HCV seroconversion in two HD units in upper Egypt, and to determine the effect of isolation policy on the incidence of HCV seroconversion in both units as well as evaluation of infection control measures.
Our study included 80 chronic HD patients divided to two groups: Group of no isolation of HCV seropositive patients (group A), this group included 45 patients, and group of isolation (group B), included 35 patients. All included patients had complete files and remain on HD for more than 2 consecutive serology tests. The patients enrolled in the study were in the periods between January 2008 and January 2010 and their files were followed up until December 2010.
All patients enrolled in this study were HCV Ab negative by ELISA third generation and HCV Ab, HbsAg and HIV Ab were reviewed every 3 months during the period of the study by ELISA 3rd generation, and full history was reviewed for assessment of risk factors related to HCV infection in hemodialysis patients such as; duration of hemodialysis (dialytic age), Previous blood transfusion in details, Previous surgery, and Vascular access insertion during and 6 months before the period of the study. Laboratory investigation results were reviewed for liver functions every 3 months, CBC, blood urea and serum creatinine were also reviewed.
In our study, although the rate of seroconversion was higher in non isolated group A (17.8%) in relation to isolated group B (8.6%). but there was no statistical significant difference between the seroconversion rates in isolated and not isolated groups.
Our study revealed that the duration of haemodialysis was statistically correlates with HCV seroconversion, this means that patients with longer duration on HD are more susceptible to HCV infection
The statistical analysis denoted that there is no significant relationship between the rate of seroconversion of the HCV negative hemodialysis patients and the number of blood units that the patients had received.
Also, the study considered that there was no significant relation between the seroconversion to HCV Ab positive state and previous history of risk factors such as dental, surgical or non surgical interventions Infection control measures in both units were evaluated using a structural check list based on Egyptian infection control guidelines.
The study revealed that there were defects in adherence to standard precautions by staff particularly compliance with hand washing 15% and 20% in unit of non isolation and unit of isolation respectively, and adherence to aseptic techniques and non touch technique and generally low scores of compliance to infection control guidelines in both units as regard processes related to the patients and processes not related to the patients.
Iatrogenic transmission of HCV infection is possible when disinfection and sterilization techniques are inadequate and contaminated equipments is shared among patients. In particular, this study had shown that HCV infection can occur among patients on haemodialysis, due to poor adherence to infection control precautions, and the sharing of contaminated supplies in spite of isolation policy, as that observed due to HCV seroconversion in group A and B with no significant difference, although the rate of seroconversion was higher in group A (not isolated patients).
This revealing that the isolation of HCV-infected patients is not recommended as an alternative to strict infection-control precautions for preventing transmission of HCV infection. If HCV seroconversion continues to occur, despite reinforcement and audit of the precautions, a local isolation policy may be deemed necessary.