Patient-to-Patient Hepatitis C Virus Transmissions Associated with Infection Control Breaches in a Hemodialysis Unit

Nicola D Thompson

doi:10.4172/2161-0959.s10-002

Abstract

Background: Three patients attending a hemodialysis unit were diagnosed with acute hepatitis C virus (HCV) infection. We investigated the scope and mode of transmission. Methods: Patients and staff were tested to determine HCV infection status; all HCV-RNA-positive sera underwent quasispecies analysis to assess genetic relatedness. Staff practices were evaluated via interviews and observations. A cohort study was performed to assess risk factors for incident HCV infection. Results: HCV infection was documented at time of hire or unit admission for 2 staff and 12 patients (prevalent case-patients). Seven (13%) of 52 patients HCV susceptible at admission to the unit subsequently acquired HCV infection (incident case-patients). Analysis of HCV quasispecies from the hyper variable region 1 identified 2 separate clusters each containing 3 incident case-patients and 1 prevalent case-patient. Incident case-patients received a higher median number of intravenous medications per dialysis session compared to susceptible patients (2.1 vs 1.8, p-value = 0.0606). Only one incident case-patient received dialysis on the same machine as their genetically related prevalent case-patient. Preparation of injection medications at the dialysis station on a mobile medication cart, and failures to clean environmental surfaces between patients were infection control breaches identified as likely modes of HCV transmission. Conclusions: Epidemiologic and laboratory data revealed transmission of HCV among patients at the same dialysis unit. Transmission was most likely related to infection control breaches. Our findings reinforce the risk of patient-to-patient HCV transmission in hemodialysis units when staff fails to adhere to recommended infection control practices.

Highlights

Three patients attending a hemodialysis unit were diagnosed with acute hepatitis C virus (HCV) infection
Due to implementation of routine screening of the blood supply and virtual elimination of HCV transmission via blood transfusion [3] and the overall declining incidence of acute HCV infection in the United States [4], intra-facility HCV transmission has been increasingly recognized as cause of incident HCV infection in hemodialysis patients [5,6,7,8,9]
Source and mode of transmission and implement necessary prevention measures a public health investigation was initiated by the Virginia Department of Health and the Centers for Disease Control and Prevention (CDC)

Summary

Methods

Patients and staff were tested to determine HCV infection status; all HCV-RNA-positive sera underwent quasispecies analysis to assess genetic relatedness. A cohort study was performed to assess risk factors for incident HCV infection. Medical records were reviewed to identify the HCV status of all patients attending the hemodialysis unit, those anti-HCV negative at the time of admission to the unit and in January 2006 (during routine annual screening) were tested monthly for anti-HCV between May and July by the facility. Potential dialysis-related risk factors, were compared using attack rates, defined as the number of incident HCV cases divided by the total number of patients with and without the risk factor assessed, and risk ratios (RR) and 95% confidence intervals (CI). Inspections of the hemodialysis unit and observation of hemodialysis treatment and patient care practices was performed on multiple days and dialysis shifts. Staff was interviewed about their routine dialysis and infection control practices at the facility

Results

Discussion

Conclusion