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    Nov 06, 2015

    Some dialysis centres flouted hep B rules

    KIDNEY dialysis centres have been warned to segregate patients with hepatitis B and properly clean equipment used by them. This is after the Ministry of Health (MOH) found that several centres flouted these guidelines.

    In an Oct 14 circular, two weeks after news of a hepatitis C outbreak at the Singapore General Hospital was made public, the ministry reminded centres to use dedicated dialysis machines and stations for those with the blood-borne virus.

    "Dialysers and bloodlines must not be shared among patients. Bloodlines shall be used once and discarded," the circular said. "We would also like to encourage, where possible, that all renal dialysis centres use dedicated dialysis machines for patients with hepatitis C and HIV infections."

    There are 95 kidney dialysis centres in Singapore. MOH declined to reveal how many centres had not been adhering to guidelines.

    According to the Singapore Renal Registry's latest report, more than half of dialysis patients in 2013 had dialysis in centres run by voluntary welfare organisations such as the National Kidney Foundation (NKF) or Kidney Dialysis Foundation (KDF).

    A third went to private centres, while the rest had their treatment at public hospitals.

    A spokesman from NKF, which has 28 centres and provides blood dialysis for nearly 3,000 patients, said it had always stuck to the guidelines and uses "separate equipment for hepatitis B cases".

    It added that patients with hepatitis B are assigned to different dialysis centres from those with hepatitis C, so as to rule out any possibility of cross infection. As of August, it had around 117 hepatitis B and 73 hepatitis C patients under its care.

    The spokesman added that these measures are undertaken because with many patients undergoing dialysis at the same time, "repeated opportunities" exist for infection to be transmitted between them.

    KDF's medical director, associate professor Lina Choong, said that all its centres use single-use dialysers - that is, artificial kidneys to help clean the blood - for hepatitis B patients.

    She also said that KDF's clinical team "actively reviews" MOH guidelines and takes measures to prevent infection.

    While private centres asked about the circular declined to comment, The Straits Times understands that some do not take in hepatitis B patients.

    Hepatitis B is spread through direct contact with the blood or other body fluids of an infected person.

    Those with hepatitis B have a higher risk of developing liver cirrhosis or liver cancer.

    People can be vaccinated against hepatitis B, while there is no vaccine for hepatitis C.

    General practitioner Yik Keng Yeong called hepatitis B a "very, very infectious virus".

    "If there is no proper sterilisation at dialysis centres, you can very easily infect the people who do not have the virus," he said.