2016 年 42 巻 8 号 p. 596-602
Reactivation of hepatitis B virus (HBV) has been reported in patients undergoing systemic chemotherapy or other immunosuppressive therapy, and prophylaxis of HBV reactivation is essential. The Japanese guidelines for HBV reactivation were published in 2009, but there have been some reports that the HBV screening prevalence was low. Therefore, we investigated the preventive measure of HBV reactivation in chemotherapy patients using the Plan-Do-Check-Act (PDCA) cycle and conducted a retrospective survey to clarify the efficacy of this measure. During the period from January 2015 to January 2016, HBV screening was defined as hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. We compared screening rates before and after starting this measure (January 4, 2015 to July 12, 2015 and July 13, 2015 to January 22, 2016, respectively). Of 440 new patients who received chemotherapy, HBV screening rates before and after starting this measure significantly increased from 24.9% to 79.2%. After starting this measure, we have carried out 6 cycles of the PDCA cycle. The HBV screening rates of each cycle were 63.3%, 65.7%, 82.1%, 86.7%, 87.9%, and 92.6%, respectively. Since the third cycle, ward-pharmacists have checked HBV screening, and the HBV screening rate has been maintained at 80% or more. Despite the HBV screening rate not reaching 100%, these results suggest that the preventive measures of HBV reactivation using the PDCA cycle are highly effective for increasing the HBV screening rate.