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Increasing Hepatitis B (HBV) and Pneumococcal Pneumonia vaccination rates is one of the current CMS Contracted AIM 1 Quality Improvement Project.  Hemodialysis patients are at greater risk for contracting HBV through contact with blood contaminated devices, equipment and supplies, environmental surfaces, and/or direct contact with dialysis facility personnel and infected patients.  Patients who receive hemodialysis have been identified by the Centers for Disease Control and Prevention (CDC) as a high-risk population for which pneumococcal vaccination is recommended.

At the time of admission to an outpatient dialysis unit each patient should be assessed for current vaccination status for Hepatitis B and Pneumococcal Pneumonia and offered them both accordingly.  At times, patients refuse vaccination potentially due to fear of contracting the disease and/or fear of needles.

This refusal of the vaccines:

  • Places them at risk for contracting HBV infection
  • Places them at risk for becoming a chronic carrier of HBV which could lead to hepatocellular carcinoma and cirrhosis of the liver
  • Increases their chances of developing pneumococcal disease which includes pneumonia, bacteremia and meningitis.

Although the rates of confirmed preventable diseases are low, as reported by the CDC, this should not lead to vaccination complacency; particularly in the population of hemodialysis patients who are immunocompromised at a higher degree than the general public.  This greater potential exposure to Hepatitis B and Pneumococcal Pneumonia is the reason for developing effective interventions for increasing vaccination rates in this targeted population.  Patients need to receive information and education on vaccines in order to understand the important health benefits of getting vaccinated.

Network Resources

This educational resource poster entitled Hepatitis B Vaccine Series is a interactive, baseball-themed way for outpatient dialysis facilities to engage the patient care team in the current vaccination rates within the clinic. The poster (and corresponding baseball player cutout) is intended for clinic staff to move the baseball player around the baseball diamond with reference to the percentage of patients vaccinated. For example, if the clinic has 20% of its patients vaccinated then your baseball player would stand just short of 1st base. That way everyone within the clinic can celebrate any and all improvements and victories large and small.

This educational resource is printed in the form of wallet cards (cardstock) entitled Hepatitis B Vaccine Series. It has a baseball theme similar to the clinic staff poster. The wallet or pocket card is intended to be given out to patients. There are slots on one side that allow the patients to keep track of the dates that they received each shot in the series for Hepatitis B. This is intended to engage the patients in their own healthcare and empower them to it a ‘home run’ with the Hepatitis B Vaccination.

Hepatitis B Liver Education

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Hepatitis B is a serious infection that affects the liver. People who are at risk for Hepatitis B infection should be vaccinated. Dialysis patients and staff are at greater risk than the normal population due to their greater chance of exposure to blood. This educational resource provides information about complications of liver infection and the importance of getting the vaccine.

The D-AFIX Guidebook was adapted by staff members from The Renal Network (ESRD Network 10) and Heartland Kidney Network (ESRD Network 12) for use by dialysis facilities for assessing vaccination practices in dialysis facilities. The Facility Staff Guidebook version provides details to the dialysis facility on how the D-AFIX model can be adapted for facility use in increasing vaccination rates for the dialysis population.

Network D-AFIX Guidebook

Download 644.45 KB 3 downloads

Staff D-AFIX Guidebook

Download 651.33 KB 3 downloads

Additional Resources

Hepatitis B Vaccine

Pneumococcal Vaccine

Other Links