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For educational use only — The physician’s written order and the unit protocol always govern
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Dialysis Nursing Reference Card  ·  Maintenance Hemodialysis

N11 — Infection Control: Hepatitis B and C, Vaccination, Isolation

Know every patient's hepatitis status, vaccinate the susceptible with a dialysis regimen, and isolate hepatitis B correctly.
Andrew Bland, MD, FACP, FAAP Reviewed September 2026 · v1.0 draft Prints on one sheet, front and back
N11 — Infection Control: Hepatitis B and C, Vaccination, Isolation FRONT
Front · at the chair

When: admission or transfer, every serology result, and every vaccine decision.

Do this

  1. New patient or transfer: hepatitis B triple panel — HBsAg, anti-HBs, total anti-HBc [4] — and an HCV screen [3], with results known before or at the first treatment per your unit protocol.
  2. Ongoing testing by status [1,3]:
    • Hepatitis B susceptible (not immune): HBsAg monthly.
    • Immune (anti-HBs 10 mIU/mL or higher): anti-HBs yearly; booster if it falls below 10.
    • Hepatitis C: antibody or RNA test every 6 months; ALT monthly.
  3. Vaccinate every susceptible patient with a hemodialysis regimen [2]:
    • Recombivax HB dialysis formulation 40 mcg — 3 doses (0, 1, 6 months), or
    • Engerix-B 40 mcg (two 20-mcg doses) — 4 doses (0, 1, 2, 6 months).
  4. Check anti-HBs 1–2 months after the last dose. Below 10 mIU/mL: repeat the full series once [1].
  5. Other vaccines per the current ACIP adult schedule: yearly influenza, pneumococcal (PCV20 or PCV21), COVID-19, RSV at 50 or older (dialysis counts as a risk condition), Tdap, recombinant zoster at 50 or older ( screening white paper §8.4, verified against CDC 2026 schedules).
  6. HBsAg-positive patient: separate room; dedicated machine, equipment, supplies, and medications; staff who are not caring for susceptible patients at the same time; no dialyzer reuse [1].
  7. Every station, every patient: clean the chair, surfaces, and machine exterior; replace transducer protectors; clean blood spills right away with a disinfectant your unit protocol approves for blood [1].

Call the nephrologist when

  • A test turns newly positive for HBsAg, anti-HBc, or HCV — same day. The unit reviews all patients’ results and serologic history; retesting is for the new case, not routine retesting of everyone [1].
  • A previously immune patient’s anti-HBs falls below 10 mIU/mL.
  • A patient has not responded to two full vaccine series.
  • ALT rises without explanation.
  • A patient dialyzed at another facility or while traveling.
  • A needlestick or blood exposure occurs — follow your exposure protocol today.

Don’t

  • Don’t give Heplisav-B to a patient on hemodialysis. CDC states its safety and effectiveness have not been established in adults on hemodialysis [2].
  • Don’t end hepatitis B isolation because the viral load is undetectable or the patient is on an antiviral. Isolation continues while HBsAg is positive [1].
  • Don’t return supplies or medications from the isolation station to general stock [1].
N11 — Infection Control: Hepatitis B and C, Vaccination, Isolation BACK
Back · why, and the evidence

Why

  1. Dialysis patients respond to standard hepatitis B vaccine far less often than the general population, and their antibody wanes faster; CDC calls for high-dose dialysis regimens, yearly anti-HBs, and a booster below 10 mIU/mL [1].
  2. Heplisav-B’s two-dose schedule is not a dialysis regimen; CDC lists Recombivax HB (3 doses) and Engerix-B (4 doses) for adults on hemodialysis [2].
  3. KDIGO 2022 recommends HCV screening every 6 months for in-center hemodialysis patients and monthly ALT [3].
  4. CDC 2023 recommends the triple panel (HBsAg, anti-HBs, total anti-HBc) to separate active infection, past infection, and immunity [4].
  5. CDC isolation for HBsAg-positive patients — separate room, dedicated machine and supplies, and staff not shared with susceptible patients — is the core of dialysis hepatitis B control [1].

Go deeper

References

  1. Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep. 2001;50(RR-5):1-43. PubMed 11349873
  2. Centers for Disease Control and Prevention. Hepatitis B vaccine administration (health care providers). Accessed 2026-09-26. cdc.gov
  3. KDIGO Hepatitis C Work Group. KDIGO 2022 guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in CKD. Kidney Int. 2022;102(6S):S129-S205. PubMed 36410841
  4. Conners EE, et al. Screening and testing for hepatitis B virus infection: CDC recommendations — United States, 2023. MMWR Recomm Rep. 2023;72(1):1-25. PubMed 36893044

Reviewed by Andrew Bland, MD, FACP, FAAP · v1.0 draft 2026-09-26. For education; the physician’s written order and the unit protocol always govern.