Identification of hepatitis C virus seroconversion resulting from nosocomial transmission on a haemodialysis unit: Implications for infection control and laboratory screening

Abstract

Hepatitis C virus (HCV) seroconversion was detected by routine screening in a haemodialysis patient, Patient 1. Serological investigations were undertaken over the following 3 months to determine if further transmission to other patients on the unit had occurred. No additional cases were identified. Twenty-two haemodialysis patients known to have HCV infection were investigated using molecular epidemiological methods to determine if transmission between patients had occurred. HCV viraemia was demonstrated by polymerase chain reaction in 19 of 22 patients (86%). Genotyping showed that eight patients were infected with genotype 1, three with genotype 3 and eight, including Patient 1, with genotype 2. Phylogenetic analysis of viral sequences from the eight patients with genotype 2 revealed three, including Patient 1,with a novel subtype of HCV type 2, and revealed close similarity between viral sequences from patient 1 and those from one other patient, suggesting transmission. This was consistent with haemodialysis histories. Among other patients with genotype 2, there were two with subtype 2a and three others with three separate novel subtypes, as yet undesignated. With the exception of patient 1, all patients infected with novel subtypes were of Afro-Caribbean origin. The HCV prevalence among patients on the haemodialysis unit was high (14%), which may reflect the ethnicity of our haemodialysis population. This case emphasises the risk of nosocomial transmission and the importance of infection control procedures on haemodialysis units, and highlights the usefulness of molecular epidemiological techniques for the investigation of outbreaks of HCV infection.

Prevalence, Seroconversion and Risk Factors of Hepatitis B and C Infection in Patients on Maintenance Hemodialysis

“…17 This observation was in agreement with previous reports in Palestine, Moldavia, and other studies from different regions of the world. [20][21][22][23] Duration of dialysis is an important risk factor for acquiring infections as it is related to nosocomial transmission and dissemination of the infections in the dialysis units. 17 While analyzing patients who seroconverted, number of blood transfusions received significantly contributed to development of either hepatitis B or C infection in our study.…”

Hepatitis C Virus Transmission in a Pediatric Oncology Ward: Analysis of an Outbreak and Review of the Literature

“…The introduction of blood donor screening and erythropoietin treatment of anemia in dialysis patients has led to a fall in both the incidence and prevalence rates of HCV infection (Simon et al, 1994). Several observations have provided evidence for nontransfusional transmission: (a) length of time on hemodialysis was shown to be an independent risk factor for infection (Kapoor et al, 1993;Pujol et al, 1996;Salama et al, 2000); (b) infection of patients with no other parenteral risk factors than hemodialysis has been observed (Cendoroglo et al, 1995;DeLamballiere et al, 1996;Jadoul et al, 1993;Kapoor et al, 1993;Katsoulidou et al, 1999;Martin et al, 1993;Medin et al, 1993;Okuda et al, 1995;Pujol et al, 1996;Seme et al, 1997;Simon et al, 1994); (c) the risk of acquiring HCV infection was directly related to the prevalence of HCV antibody-positive patients being treated at some units ; (d) newly infected patients have often shown overlapping hemodialysis history (dialysis at the same time, during the same shift, in the same area) with HCV-positive patients (Allander et al, 1994;Irish et al, 1999;Izopet et al, 1999;Jadoul et al, 1993;Katsoulidou et al, 1999;McLaughlin et al, 1997;Norder et al, 1998;Okuda et al, 1995), and (e) there has been a lower prevalence (Chan et al, 1991;Pascual et al, 1993) and incidence of HCV infection in peritoneal dialysis (Cendoroglo et al, 1995;Medin et al, 1993).…”

“…Recently, a variety of studies have provided, by sequence analysis, reliable molecular evidence for patient-to-patient transmission (Abacioglu et al, 2000;Allander et al, 1994;DeLamballiere et al, 1996;Grethe et al, 2000;Hosokawa et al, 2000;Irish et al, 1999;Izopet et al, 1999;Katsoulidou et al, 1999;LePogam et al, 1998;McLaughlin et al, 1997;Norder et al, 1998), but the exact mode of transmission could not be established. In most cases, breaching or neglecting of hygienic precautions was suspected.…”

Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting

“…In the United States, in a survey of dialysis centers conducted in 2000, antibody directed against HCV was found in 1.7% of hemodialysis center staff and in 8.4% of patients at these centers (346). Although chronic, end-stage renal failure patients do receive transfusions of blood and blood products, an increasing number of instances of nosocomial, patient-to-patient spread of infection as well as outbreaks of infection not linked to transfusion have been reported (1,9,56,78,88,99,100,131,136,159,160,170,198,213,238,248,316,326,333).…”

“…Spread in these units has been suggested (but not definitively proved) to be due to environmental contamination (1,7,8,78,198,366), contaminated dialysis machines (21, 78,198), inadequate infection control procedures in the dialysis unit (1,56,78,88,159,198,345), dialyzing infected and noninfected patients in the same area (56, 88,160,248,333), and understaffing of the dialysis unit (248). Numerous cases of patient-to-patient HCV transmission have been linked to breaks in infection control technique (discussed in more detail below).…”