Following an investigation into an outbreak of 22 cases of HCV infection that occurred at a hemodialysis center in southern France in 2001, the Minister of Health asked the French Institute for Public Health Surveillance (InVS) to conduct a study on the prevalence of HCV infections among dialysis patients. This work was undertaken by the InVS in collaboration with the Centers for the Control of Nosocomial Infections (CClin) and representatives of nephrology professional societies. For reasons of feasibility, the decision was made to conduct a survey focusing on practices deemed a priority for improving the prevention of HCV infection risks. An initial questionnaire survey was sent by the InVS to all adult hemodialysis centers and units in France. In a second phase, the InVS, the CClin, and the Francophone Dialysis Society (SFD) sought to conduct an observational audit of practices on a sample of 10% of hemodialysis centers and units. The first survey was coordinated by the InVS and conducted via questionnaire among French hemodialysis facilities from October to December 2004. The questionnaire focused on HCV screening practices and hygiene and prevention practices regarding HCV transmission. Of the 873 hemodialysis facilities contacted, 477 (55%) participated, including 200 hemodialysis centers and 277 self-dialysis units. The prevalence of HCV among dialysis patients in the week preceding the survey was 6.6% in hemodialysis centers and 5.9% in self-dialysis units. Testing for anti-HCV antibodies was performed upon the patient’s admission to the facility by 91% (432) of the facilities. The frequency of HCV antibody testing was at least every six months for 368 (77%) of the hemodialysis facilities. Among the recommended hygiene practices, some were followed by more than 90% of the hemodialysis facilities. These included wearing gloves during care involving exposure to blood or body fluids, using containers for the disposal of sharp objects, cleaning the surfaces of the generators after each dialysis session, and disinfecting the internal circuits of the generators. Other practices, such as wearing protective equipment during procedures involving exposure to blood or body fluids, and installing filters to protect the arterial or venous pressure sensors on the generators, should be improved, as 30% or more of the centers or units reported practices that were not fully in line with the recommendations. Difficulties were also mentioned regarding the maintenance of small equipment shared among patients and the use of multi-dose vials. The second survey was coordinated by CClin Sud-Est and conducted through a practice audit. It aimed to evaluate hygiene practices during the key stages of a dialysis session (connecting the generator, disconnecting it, and maintaining the environment). The audit also focused on compliance with hand hygiene and the wearing of gloves by healthcare providers during care procedures. Additionally, a questionnaire examined protocols, equipment, staff, and the organization of care in the audited centers. The recent recommendations from the French Society of Hospital Hygiene on "Best Practices in Hemodialysis" served as the reference framework. The audit took place between May 15 and October 30, 2005, with a team of two investigators (CClin and a local expert) per center. The audit covered 32 randomly selected centers; 64 healthcare providers were observed during 191 patient connection sessions and 187 patient disconnection sessions, as well as during 643 additional opportunities. The results show a high rate of compliance with recommendations, though with areas for improvement: systematic implementation of the four-step antisepsis protocol for patients with fistulas and central venous catheters, raising awareness of standard precautions, improving hand hygiene compliance by increasing the use of hydroalcoholic solutions, reducing the risk of environmental cross-transmission through better management of shared equipment and optimization of care organization. Awareness of the risk of cross-transmission of bloodborne viruses, as well as hygiene training for hemodialysis staff, should be encouraged. Similarly, it appears necessary to improve information for dialysis patients by offering them a more participatory approach. These two surveys, the first conducted at the national level on this subject, provide a better understanding of HCV screening practices and hygiene protocols in hemodialysis. They will enable the optimization of prevention messages in the future and guide the communication and training strategy regarding hygiene in hemodialysis. (R.A.)