Authors (including presenting author) :
Tse KC(1), Yuen SK(1), Cheong HY(1), Chan KY(1), Shik TC(1)
Affiliation :
Renal Unit, Caritas Medical Centre
Introduction :
Patients with chronic kidney disease (CKD) are at risk of hepatitis infections. Loss of protective antibodies may occur in kidney transplant recipients or patients on dialysis. Prioritization of resources to tackle the COVID-19 pandemic undermined local efforts on hepatitis screening and vaccination programs that had operated for years to optimize patients’ protection, albeit lack of international consensus on screening schedule and booster vaccination regime. Suboptimal herd immunity increased risks of sporadic nosocomial outbreak.
Objectives :
Revamp the hepatitis B vaccination programme of all dialysis patients and enhance hepatitis control in the renal unit of Caritas Medical Centre
Methodology :
The nurse-led hepatitis B vaccination programme for renal patients ceased in 2019 because of the COVID-19 pandemic. We embarked on a continuous quality improvement (CQI) initiative with an aim to improve individual and centre control of hepatitis. The hepatitis B vaccination guideline for CKD patients was re-written and expanded in December 2023 to include non-vaccination infection control measures in the high-risk HD suite, such as hepatitis surveillance and machine allocation. All kidney transplant recipients should have yearly screening of HBsAg, Anti-HBs and anti-HCV while all dialysis patients were screened with an individualized scheduled as determined by their hepatitis serostatus. A dedicated renal nursing team, led by an Advanced Practice nurse (APN) and supervised by the renal team head was responsible for reviewing all patients’ vaccination history and serostatus, scheduling blood taking and recommending vaccination regimes. Documentation of the recommendations as non-consultation notes served as reminders to doctors in the patients’ next clinic visit. The APN keep track of patients’ vaccination progress subsequently.
Result & Outcome :
From January to July 2024, we performed hepatitis screening and vaccination history review on 312 peritoneal dialysis patients, 68 HD patients and 51 transplant recipients. The APN identified 143 patients for hepatitis B vaccination, proposed the regimes and documented them in the CMS. The renal doctor prescribed vaccination according to the prescription in 46.2 % of the cases. Vaccine prescription was temporarily skipped by doctor in 53.8% of cases due to lack of time in a busy clinic. After the interim analyses and engagement, all doctors were aware of the programme, appreciated nurses’ contribution and believed the program would lead to better patients’ care. This CQI project would ultimately improve hepatitis B vaccination programme effectiveness. Collaboration between renal nurses and doctors would be the key to success.
