Shared dialysis machine leads to hepatitis B concern
Tuen Mun Hospital error sees 79 kidney disorder patients exposed to infection risk from sufferer
Some 79 patients given kidney dialysis have been found to have shared the same machine as a patient with hepatitis B, in the second blunder involving Tuen Mun Hospital reported in a week.
The hospital said a 66-year-old female patient with chronic kidney failure had been assigned for a year to use a haemodialysis machine used by other patients with renal disorders despite her being diagnosed with hepatitis B in November last year.
Patients with hepatitis B are not meant to use machines used by other patients suffering from renal disease under anti-infection measures. It should be arranged for such patients to use a specially designated machine.
Haemodialysis machines remove waste in the blood for those whose kidneys are no longer able to do so.
A hospital spokeswoman said the risk of infection for the 79 patients who had shared the machine was “very minimal” because all dialysis machines were disinfected after every single session of use and all viruses including hepatitis B would be killed.
Tubes connecting to the machines were also disposable, and a new tube is connected before the next patient comes in for treatment, she said.
The hospital was in the process of contacting the 79 patients who had shared the machine. Twenty-one of them who were frequent users undergoing treatment two or three times a week were confirmed as hepatitis B free in a blood test this month. Follow-up blood tests would be arranged for them, the spokeswoman said.
For the 58 non-frequent users of the same machine, the hospital will also arrange blood tests.
A panel will be set up to investigate why the woman was still allowed to use the machine after being diagnosed with hepatitis B.
It will also make recommendations to avoid any occurrence of similar incidents.
An investigation report will be submitted within eight weeks.
Last week, a 49-year-old man receiving care at Tuen Mun Hospital was fighting for his life after air bubbles were found in an artery during a procedure to open it dubbed percutaneous coronary intervention.
Nephrologist Chau ka-foon agreed that the risk of infection for those patients would be low as the haemodialysis system was a closed one in which no part of the machine came into contact with a patient’s blood.
She said the separation of renal patients with and without hepatitis B for haemodialysis in the city’s public medical system was an extra precaution not adopted in other developed regions.