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

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 \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-4)\] — and an HCV screen \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-3)\], with results known before or at the first treatment per your unit protocol.
2.  **Ongoing testing by status** \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1),[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-3)\]:
    - 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** \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-2)\]:
    - **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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].
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](https://urinenephrology.org/mastery/dialysis-advanced/screening-tests-hemodialysis.html) §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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].
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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].

### 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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].
- 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 \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-2)\].
- 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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].
- Don’t return supplies or medications from the isolation station to general stock \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].

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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].
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 \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-2)\].
3.  KDIGO 2022 recommends HCV screening every 6 months for in-center hemodialysis patients and monthly ALT \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-3)\].
4.  CDC 2023 recommends the triple panel (HBsAg, anti-HBs, total anti-HBc) to separate active infection, past infection, and immunity \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-4)\].
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 \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html#n11-ref-1)\].

### Go deeper

- Mastery page: [Infection Screening and Vaccination in Maintenance Hemodialysis](https://urinenephrology.org/mastery/maintenance-hd/infection-screening-vaccination-hd.html)
- Complete white paper: [Screening and health maintenance in maintenance hemodialysis](https://urinenephrology.org/mastery/dialysis-advanced/screening-tests-hemodialysis.html)
- [All dialysis nursing reference cards](https://urinenephrology.org/mastery/maintenance-hd/nursing/index.html)

### 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](https://pubmed.ncbi.nlm.nih.gov/11349873/)
2.  Centers for Disease Control and Prevention. Hepatitis B vaccine administration (health care providers). Accessed 2026-09-26. [cdc.gov](https://www.cdc.gov/hepatitis-b/hcp/vaccine-administration/index.html)
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](https://pubmed.ncbi.nlm.nih.gov/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](https://pubmed.ncbi.nlm.nih.gov/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.


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[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N11-Infection-Control-Hepatitis-Vaccination.html) · Markdown synchronized October 3, 2026.