Renal: Hepatitis B Vaccination for Chronic Renal Failure Patients – Doc #
Guideline and
Procedure
Hepatitis B vaccination regime for adult chronic renal failure patients
Document Number:
Sites where Guideline and Procedure
applies:
All HNE facilities where a patient undergoes Haemodialysis
Target audience:
Nephrology clinical staff, who provide care to haemodialysis
patients within a hospital facility or satellite dialysis unit.
This document comprises part of the clinical information
package for care for Haemodialysis patients.
Hepatitis B, Vaccination,
Description:
Keywords:
Replaces Existing Guideline and
Procedure:
Yes
Registration Number(s) and/or name and
of Superseded Documents:
JHH Nephrology SWP N.4.15
Relevant or related Documents, Australian Standards, Guidelines etc:
 NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
 NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
 NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
Prerequisites (if required):
Registered Nurse or Endorsed Enrolled Nurse. Current, signed medication
order.
Procedure Summary:
This Guideline and Procedure sets out the steps to be followed when
carrying out Hepatitis B screening for a haemodialysis patient. The
procedural components of the document such as, Preparation of patient,
Preparation of equipment, Technique, Cleaning up and Documentation are
considered mandatory.
Guideline Note :
This document reflects what is currently regarded as safe and appropriate
practice. However in any clinical situation there may be many factors that
cannot be covered by a single document and therefore does not replace
the need for the application of clinical judgment in respect to each
individual patient.
Date authorised:
05/08/2010
Authorised by:
Contact Person:
HNEAHS Renal Clinical Stream Leadership Group
Kelly Adams
Contact Details:
49048800
Review due date:
TRIM Number:
Version One
June 2010
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Renal: Hepatitis B Vaccination for Chronic Renal Failure Patients – Doc #
OUTCOMES
1
To make certain that all patients referred to the Pre dialysis pathway and patients already
commenced on dialysis are immunised against Hepatitis B.
GUIDLEINE
Hepatitis B vaccinations are an essential part of the pre-dialysis pathway. It is also important that
patients already commenced on dialysis are screened and immunised if necessary. A total of 3
Hepatitis B vaccines are given at 0, 1 and 6 months.
Four to eight weeks following the final vaccination a blood test is conducted to determine immunity
status. A key reason to consider for non response to vaccine is that the patient might be HBsAg
positive, so a check carriage status should be made prior to giving further doses of the vaccine.
If Hepatitis B immunity is not reached after the 3rd dose, further doses should be administered, this
can be as a 4th dose or a further three doses at monthly intervals, with serology attended at least 4
weeks following last dose.
Intradermal administration is also an option of vaccination if the patient does not seroconvert
Pre- Dialysis Patients- Following referral from nephrologist to the pre dialysis pathway virology is
arranged by the Pre Dialysis Coordinator. If immunity not detected a prescription for Hepatitis B
vaccine is organised. The patient is to collect script and arrange for their GP to administer. Patients
are to inform Coordinator at commencement of vaccine regime.
If immunity is not detected or patient has not been vaccinated on commencement of dialysis
treatment consult with Nephrologist to arrange immunization as soon as possible.
PROCEDURE
The procedure requires mandatory compliance.
Patient Preparation
It is mandatory to ensure that the patient has received appropriate information to provide informed
consent and, that patient identification, correct procedure and correct site process is completed
prior to any procedure.
1. Educate patient on importance of ensuring immunisations are current
Staff Preparation
It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection control,
moving safely/safe manual handling, and documentation practices.
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June 2010
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Renal: Hepatitis B Vaccination for Chronic Renal Failure Patients – Doc #
Precautions:
The HBV vaccine should not be administered to anyone with a known hypersensitivity to any
component of the vaccine, e.g. Yeast or anyone that has shown signs of hypersensitivity following
previous administration the HBV vaccine. The vaccine should not be administered to anyone with
febrile infections.
Adverse Reactions:
Anaphylaxis to the HBV vaccine has rarely been reported in adults, however ensure emergency
equipment is available at time of administration, including adrenaline and airway management.
Adverse reactions after HBV vaccination are usually transient and minor and include soreness at
the injection site, fever, nausea, dizziness, malaise, myalgia and arthralgia. (Refer to the product
information leaflet for further information).
Equipment Requirements




Alcohol hand gel
Personal Protective Equipment
Pathology request for screening
Prescription for vaccine
Procedure Steps
1. All Pre- Dialysis patients and patients already commenced on haemodialysis are to
complete 3 vaccination course of current Hepatitis B vaccine currently available. Vaccines
are to be given at 0, 1 and 6 months.
2. Current doses are recommended
3. 0 months- 40 microgram/mL via IMI injection
4. 1 months- 40 microgram/mL
5. 6 months- 40 microgram/mL
6. 4 to 8 weeks following 3rd vaccination serology should be attended to determine immunity
7. If Hepatitis B surface antibody falls below recommended levels (>10) or shows poor
seroconversion after initial immunisation regime a single booster can also be offered.
Administration of IM Injection:
• Patients receiving anticoagulant therapy during dialysis should have the vaccine administered 30
minutes prior to dialysis (for IMI).
• Check patient, order and vaccine dose and expiry date.
• Explain the procedure to the patient and obtain consent and provide with consumer product
information leaflet.
• The vaccine is a ready to use suspension and should be shaken well before use. The vaccine
should be a slightly opaque, white suspension, discard if appears otherwise.
• Prepare the site with alcohol swab and allow to dry thoroughly (alcohol may affect the
effectiveness of the vaccine) administer the vaccine deep in the deltoid muscle. The schedule is as
per the prescribing information: IM injections (deltoid muscle) at 0, 1 and 6 months.
• Following administration the patient should stay in the area for 15 minutes to observe for any
signs of adverse reactions.
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Renal: Hepatitis B Vaccination for Chronic Renal Failure Patients – Doc #
• The vaccine must be signed for and the batch number noted, on the Immunisation Record Form
which is to be kept at the front of the patients most current medical record chart (or as per local
hospital procedures).
• The Hepatitis B surface antibody should be checked approximately four to six weeks after the last
injection. A 4th dose may be required, if the anti-HBs <10 IU/L.
• If the Anti-HBs IU/L is still <10 following booster vaccination, it is advisable to proceed with IntraDermal HBV vaccination.
Administration of Intra-Dermal Injection:
• Patients receiving anticoagulant therapy during dialysis can have the vaccine administered via
the Intra-Dermal Injection method during the treatment as there are less likely to be complications
from this injection method.
• Check patient, order and vaccine dose and expiry date.
• Explain the procedure to the patient and obtain consent and provide with consumer product
information leaflet.
• The vaccine is a ready to use suspension and should be shaken well before use, the vaccine
should be a slightly opaque, white suspension, discard if appears otherwise.
• Registered Nurses will have undergone ward-based immunisation training can administer the
Intra-Dermal injection. Prepare the site with alcohol swab and prepare two separate Intra-Dermal
injections of 0.25ml (5ug Engerix B) via an insulin syringe or 27G needle. Inject using Intra-Dermal
Injection technique into the volar aspect of the forearm. Ideally the injection sites will be approx.
4cm apart in width, and be on the arm with no vascular access.
• The schedule is on a weekly basis for 8 weeks – a total of 80ug. A schedule outlining dates as
well as a medical prescription will be organised by the Haemodialysis Infection Control portfolio
group or allocated nurse.
• Following administration the patient should stay in the area for 15 minutes to observe for any
signs of adverse reactions.
• The vaccine must be signed for and the batch number noted, on the Immunisation record form
which is to be kept at the front of the patients most current medical record chart (or as per local
hospital policy).
• The Hepatitis B surface antibody should be checked approximately four to six weeks after the last
injection. If antibody titre continues to be <10 IU/L, the notes should reflect that the patient is an ID
Hepatitis B non-responder and no further Hepatitis B vaccination undertaken
APPENDICES
Five Moments for Hand Hygiene
REFERENCES
Australia Immunisation Handbook 9th Edition, Section 3.6 Hepatitis B
Hand Hygiene Australia 2008: Five Moments for Hand Hygiene
Hepatitis Australia. (2009). Hepatitis B. Accessed 7/01/10
http://www.hepatitisaustralia.com/about_hepatitis/hep_b.html Queensland Government,
Queensland Health, Procedure no. 01191/V1/2012. Hepatitis B Immunisation for Renal
Patients: Monitoring. 2012
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Renal: Hepatitis B Vaccination for Chronic Renal Failure Patients – Doc #
Appendix 1
Adopted from the World Health Organization and Hand Hygiene Australia.
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