The Carl Moyer Program, 2003 guidelines;program advisories, current guidleines,AB 923,Assembly Bill 923. A; Name Title POC Email Phone Floor Division/Office; Addey, Carolyn: Program Analyst : [email protected] (202) 606-8466 : 4 : Division of Research Programs : Aiken, Tim: Director of Congressional. Readbag users suggest that GSA11. The file contains 194 page(s) and is free to view, download or print. Important Notices: NEW! The South Coast Air Quality Management District (SCAQMD) is no longer accepting applications for the Proposition 1B - Goods Movement Emission Reduction Program (Program Announcement # 2016-10). Air Quality Summaries; Current Air Quality; Open Burn Map; Air Quality Forecast; Incidents & Advisories; Spare the Air; What You Can Do; Glossary; Wood Smoke; Lab Source Test; Air Quality Main Page; Rules. Anterior Segment Optical Coherence Tomography (AS-OCT) Sarah Moyer, CRA, OCT-C Director, Ophthalmic Imaging University of North Carolina Chapel Hill, North Carolina. OCT is a well known and. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. Terms and Abbreviations Used in This Publication. Acute hepatitis B. Newly acquired symptomatic. B virus (HBV). infection. Environmental Protection Agency. Food and Drug Administration. Bailey, M. D. Emory University School of Medicine. Atlanta, Georgia. Paul Balter, M. D. Everest Health Care. Oakville, Illinois. Jeffrey Berns, M. D. American Society of Nephrology. Washington, D. C. Edwards, M. D. Emory University School of Medicine. Atlanta, Georgia. Martin S. Favero, Ph. D. Advanced Sterilization Products. Irvine, California. John Foreman, M. D. American Society of Pediatric Nephrology. Cleveland, Ohio. Michael W. Fried, M. D. University of North Carolina. Chapel Hill, North Carolina. Vasant Gandhi, M. D. Vines Veteran's Administration Hospital. Vines, Illinois. Clifford Glynn. National Association of Nephrology. Technicians. Dayton, Ohio. Ray Hakim, M. D., Ph. D. Renal Care Group, Inc. Nashville Tennessee. Norma Heard. Grady Dialysis Unit. Atlanta, Georgia. J. Michael Lazarus, M. D. Fresenius Medical Care, NALexington, Massachusetts. Nathan Levin, M. D. Association for the Advancement of Medical. Instrumentation. New York, New York. Paul Light, M. D. Forum of ESRD Networks. Baltimore, Maryland. Stan Lindenfield, M. D. Total Renal Care. Torrance, California. Cynthia Marshall. Renal Treatment Center. Atlanta, Georgia. Bela T. Matyas, M. D., M. P. H. Council of State and Territorial. Epidemologists. Atlanta, Georgia. Joseph Mazilli. Hackensack University Medical Center. Hackensack, New Jersey. Barbara Mc. Cool, M. S. U. S. Food and Drug Administration. Rockville, Maryland. Ira Meisels, M. D. Renal Physicians Association. Rockville, Maryland. Catherine M. Food and Drug Administration. Rockville, Maryland. Svetlozar Natov, M. D. Tufts University School of Medicine. Newton, Massachusetts. Cathy D. Food and Drug Administration. Rockville, Maryland. Stephen Pastan, M. D. Emory University School of Medicine. Atlanta, Georgia. Eileen Peacock, M. S. N. Total Renal Care. Maple Glen, Pennsylvania. Jacquelyn Polder, M. P. H. Health Care Financing Administration. Seattle, Washington. Robert Sharbaugh, Ph. D. Association for Professionals in Infection. Control, Inc. Charleston, South Carolina. Gayle Shimokura. University of North Carolina. Chapel Hill, North Carolina. James Steinberg, M. D. Emory University School of Medicine. Atlanta, Georgia. Charlotte Thomas- Hawkins, Ph. D. American Nephrology Nurses Association. Pitman, New Jersey. Stephen Vas, M. D. Toronto Western Hospital. Toronto, Ontario, Canada. Brian A. J. Walters, Ph. D. Gambro Healthcare. Ft Lauderdale, Florida. David J. Weber, M. D. University of North Carolina- Chapel Hill. Medical School. Chapel Hill, North Carolina. Rebecca Wingard, M. S. N. Renal Care Group, Inc. Nashville, Tennessee. Jay Wish, M. D. Forum of ESRD Networks. Cleveland, Ohio. AGENCY LIAISON CONSULTANT. Paul W. Eggers, Ph. D. Health Care Financing Administration. Baltimore, Maryland. The following CDC staff members prepared this report: Miriam J. Lyerla, Ph. D. Division of Viral and Rickettsial Diseases. National Center for Infectious Diseases. Jerome I. Tokars, M. D., M. P. H. Elaine R. Miller, M. P. H. Matthew J. Arduino, M. S., Dr. P. H. Hospital Infections Program. National Center for Infectious Diseasesin consultation with. Lawrence Y. C. Agodoa, M. D. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. Carolyn Y. Neuland, Ph. D. Center for Devices and Radiologic Health. U. S. Food and Drug Administration. Summary. These recommendations replace previous recommendations for. The recommendations in this report provide guidelines for. Implementation of this program in hemodialysis centers will. Based on available. CDC after consultation with. Atlanta on October 5- -6, 1. They are summarized in the. Recommendations section. This report is intended to serve as a resource for. INTRODUCTIONThe number of patients with end- stage renal disease treated by. United States has increased sharply during the past 3. Chronic hemodialysis patients are at. In an environment where multiple patients receive. Furthermore. hemodialysis patients are immunosuppressed. CDC. began conducting national surveillance for hemodialysis- associated hepatitis in 1. Since 1. 97. 6, this surveillance has been performed in collaboration with the. Health Care Financing Administration (HCFA) during its annual facility survey. In 1. 98. 2, hepatitis B vaccination was recommended for. However, outbreaks of both HBV and hepatitis C virus (HCV) infections continue to occur among chronic. Epidemiologic investigations have indicated substantial deficiencies. B. (2. 1,2. 2). These practices apparently are not being fully implemented because staff members a) are not aware of the practices. B vaccine is ineffective for preventing HBV infection in chronic hemodialysis. During the 1. 99. Staphylococcus aureus . Although numerous outbreaks of bacterial infections in the hemodialysis setting have been reported. In 1. 99. 9, CDC initiated a. They are summarized on pages. In 1. 97. 4, the incidence of newly acquired (i. HBV infection among chronic hemodialysis patients in the United States was. By 1. 98. 0, nationwide incidence among patients had decreased to 1%. CDC, unpublished data, 2. Prevalence of chronic HBV infection (i. B surface antigen . In 1. 99. 9, a total of 2. HBV infection (CDC, unpublished data, 2. HBV is transmitted by percutaneous (i. HBV transmission. All. HBs. Ag- positive persons are infectious, but those who are also positive for hepatitis B e. HBe. Ag) circulate HBV at high titers in their blood. L) (2. 6,2. 7). Furthermore, HBV at titers of. L can be present on environmental surfaces in the absence of any. HBs. Ag has been detected in dialysis centers on clamps, scissors, dialysis machine control knobs, and. Thus, blood- contaminated surfaces that are not routinely cleaned. HBV transmission. Dialysis staff members. Once the factors that promote HBV transmission among hemodialysis patients. These recommendations included a) serologic surveillance of patients (and staff. HBV infection, including monthly testing of all susceptible patients for HBs. Ag. b) isolation of HBs. Ag- positive patients in a separate room; c) assignment of. HBs. Ag- positive patients and not to HBV- susceptible patients during. HBs. Ag- positive patients that. HBV- susceptible patients; e) assignment of a supply tray to. National surveillance data for. HBV infection was substantially lower in. HBs. Ag- positive patients, compared with those that did not. The success of isolation practices in preventing transmission of HBV infection. Frequent serologic testing for HBs. Ag. detects patients recently infected with HBV quickly so isolation procedures can. Environmental control. Investigations of. HBV transmission resulted from failure to. HBs. Ag or routinely review results of testing to identify infected. In addition, few patients had received hepatitis B vaccine. National surveillance data have demonstrated that independent risk factors. HBV infection include the presence of. HBV- infected patient in the hemodialysis center who is not isolated, as well as. B vaccination rate among patients. Transmission appeared to stem from chronically infected HBV patients who shared staff members. These episodes were recognized when patients returned to their. HBs. Ag testing was resumed. Transmission. from HBV- infected chronic hemodialysis patients to patients undergoing hemodialysis. However, such. transmission could go unrecognized because acute renal failure patients are unlikely to be. HBV infection. The incubation period ranges. Infants, young children (aged < 1. HBV infection are usually asymptomatic. When present, clinical symptoms and signs might include anorexia, malaise, nausea, vomiting. Extrahepatic manifestations of disease (e. The case fatality rate after acute hepatitis B is 0. In immunosuppressed persons (including hemodialysis patients), infants, and. HBV infections result in chronic infection. Although persons with chronic HBV infection are often asymptomatic, chronic. However, reinfection or reactivation of latent HBV. HIV) (4. 6,4. 7). These patients were positive for antibody. B core antigen (anti- HBc), with or without antibody to HBs. Ag (anti- HBs). and subsequently developed detectable levels of HBs. Ag. The frequency with which. Although the dosage of lamivudine should be modified based on. The emergence of. Several well- defined antigen- antibody systems are. HBV infection, including HBs. Ag and anti- HBs; hepatitis B core antigen. HBc. Ag) and anti- HBc; and HBe. Ag and antibody to HBe. Ag (anti- HBe). Serologic assays. HBc. Ag because no free. HBc. Ag circulates in blood. One or more of these serologic markers are present. HBV infection (Table 1). In newly infected persons, HBs. Ag is present in serum 3. HBV and persists for variable periods. Transient HBs. Ag. Anti- HBc develops in all HBV infections, appearing at onset of symptoms or liver. HBV infection, rising rapidly to high levels, and persisting. Acute or recently acquired infection can be distinguished by presence of. M (Ig. M) class of anti- HBc, which persists for approximately. The presence. of anti- HBs indicates immunity from HBV infection. After recovery from. HBs and anti- HBc, whereas. HBs develops in persons who are successfully vaccinated against hepatitis. B. Persons who do not recover from HBV infection and become chronically. HBs. Ag (and anti- HBc), although a small proportion (0. HBs. Ag and might develop anti- HBs. Among most asymptomatic persons in the United States tested for. HBV infection, an average of 2% (range: < 0. HBc. (5. 2); among injecting- drug users, however, the rate is 2. In general, the frequency of isolated anti- HBc is directly related to the frequency of previous HBV infection. This pattern can occur after. HBV infection among persons who have recovered but whose anti- HBs levels have. HBs. Persons in the latter. HBs. Ag at levels not detectable by current. However, HBV DNA has been detected in < 1.
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