Name of unit:                                                                                                    Identifier number:

Please answer the following questions on Hepatitis B immunisation policy in your unit. It is really important to get a good response rate for this survey, so if there are questions for which you do not know the answers, please leave them blank rather thanput the questionnaire aside.

1.  Do you treat patients with end stage renal failure [ESRF] in your unit? Yes / No
 

2.  Have you had any incidents of Hepatitis B seroconversion in ESRF patients on your unit in the last 3 years?
     Yes / No
 

3. Specify which of the following groups are offered Hepatitis B immunisation in your unit:

[You may tick more than one category]
 

Groups	None	Someg	Most g	All	specify categories where possible
all pre-dialysis patients under your care
haemodialysis
peritoneal dialysis
transplant
patients who will be treated  outside Britain
other groups [specify]

g [For ‘some’ use approximately<50%, for ‘ most’ use approximately >50%]

If you have answered ‘none’ for all categories, please be sure to answer Question 8.
 
 

4. How are candidates for Hepatitis B immunisation identified?
 

by doctors in pre-dialysis clinic		by clerical staff		by GPs in primary care
by nurses in pre-dialysis clinic		by nurses on the renal unit

Other [please specify]:
 
 

5.  Who is currently responsible for administering Hepatitis B immunisation locally?
[please tick one box on each line]
 

	Hospital	GP	Both	Neither
Pre-dialysis
ESRF

 

6. Please estimate the Hepatitis B immunisation coverage you are achieving in dialysis patients?
 

<25%

25-50%

50-75%

75-100%

don’t know

 

7. What dose and schedule do you use to immunise against Hepatitis B in chronic renal patients? [tick boxes]
 

Dose:	Normal [20 mcg]		High [40mcg]
Schedule:	Normal [0, 1, 6 months]		Accelerated [0,1, 2, 12 months]

 

8. Please identify in each column reasons why patients are not routinely vaccinated in your unit [put reasons considered significant in rank order from 1= most important reason, 2,3 etc]
 

[key: P = predialysis, E= ESRF]	P		E
a. poor efficacy of the vaccine in patients on dialysis
b. lack of awareness of the higher dose vaccine [40mcg]
c. effectiveness of universal precautions and screening of blood donors and patients
d. low perceived risk: outbreaks are rare
e. not cost-effective
f. logistics of administration and monitoring
g. should be done in primary care
h. awaiting revised guidelines from dialysis units committee

If no, does your unit have a written local policy on immunisation of patients with chronic renal failure against Hepatitis B?Yes / No [If yes please send us a copy]

Are you aware of any other guidance on Hepatitis B immunisation for patients with chronic renal failure? Yes / No Please state which:

10. Do you have any further comments that would be useful for us?
 

Thank you for taking the time to fill in this questionnaire. Please fill in your name and contact number in case we need to speak to you directly. Send the questionnaire in the pre-paid envelope to Dr S Ray, CDSC [West Midlands], 2^nd floor Lincoln House, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS. Phone 0121 773 7077.

Name of person completing questionnaire: ……………………………………………………………

Position/title of respondent in unit: …………………………………………………………………..

Contact telephone / email number:……………………………………………………………………

Date : …………………………………..