Awareness of Nephrology Fellows regarding Hepatitis B Vaccination in Patients with CKD Approaching Dialysis

Background: Dialysis patients face a heightened risk of hepatitis B infection due to their immunocompromised state and frequent exposure to body fluids. Vaccinating these patients is cost effective than monthly monitoring of antigen/ antibody titers. Due to immunosuppression, they are prone to becoming chronic carriers. Our goal is to raise awareness, enhance knowledge and improve the hepatitis B vaccination rate among chronic kidney disease (CKD) patients. Methods: We developed a tool including questionnaire to evaluate Nephrology fellows’ perception of the importance of Hepatitis B vaccination in CKD patients, followed by one-on-one discussion with a nephrology attending. This study was conducted over a year. Results: In the year prior to the educational intervention, 34 new patients were admitted to our outpatient dialysis unit, of these 10 patients (29%) were vaccinated meaning 24 patients (71%) were unvaccinated before starting dialysis. After implementing the educational program, a follow-up questionnaire revealed that the fellows’ proficiency in hepatitis B vaccination knowledge increased from 70% to 90% following the lecture. This indicated a significant improvement in awareness and understanding which we hope will translate into higher vaccination rate among CKD patients. We reviewed new ESRD admissions a year later to assess the impact of improved awareness among fellow physicians. Charts of newly admitted patients revealed that 46 patients started chronic dialysis. Among them 15 (32%) needed vaccination at the initiation of dialysis while 31 (67%) were vaccinated beforehand. Table 1 Conclusion: The data indicated that although fellows’ clinical knowledge improved after the educational intervention, their effectiveness in ensuring patients received the vaccination did not show significant improvement. To enhance the fellows’ efficiency in vaccination, the next step could be to ensure standardizing the process of Hepatitis B vaccination in CKD patients, which can be implemented by order bundle set for chronic kidney disease in the electronic medical records (EMR).