Nosocomial Transmission of Hepatitis C Virus Associated With the Use of Multidose Saline Vials

Abstract

Objective:To identify the source of an outbreak of acute hepatitis C virus (HCV) infection among 3 patients occurring within 8 weeks of hospitalization in the same ward of a Florida hospital during November 1998.Design:A retrospective cohort study was conducted among 41 patients hospitalized between November 11 and 19, 1998. Patients' blood was tested for antibodies to HCV, and HCV RNA-positive samples were genotyped and sequenced.Results:Of the 41 patients, 24 (59%) participated in the study. HCV genotype 1b infections were found in 5 patients. Three of 4 patients who received saline flushes from a multidose saline vial on November 16 had acute HCV infection, whereas none of the 9 patients who did not receive saline flushes had HCV infection (P= .01). No other significant exposures were identified. The HCV sequence was available for 1 case of acute HCV and differed by a single nucleotide (0.3%) from that of the indeterminate case.Conclusion:This outbreak of HCV probably occurred when a multidose saline vial was contaminated with blood from an HCV-infected patient. Hospitals should emphasize adherence to standard procedures to prevent blood-borne infections. In addition, the use of single-dose vials or prefilled saline syringes might further reduce the risk for nosocomial transmission of blood-borne pathogens.

Mechanisms of Methods for Hepatitis C Virus Inactivation

“…However, there is still no protective vaccine available, rendering healthcare workers at a constant risk of acquiring HCV from occupational exposure. In addition, nosocomial transmission of HCV still accounts for a large proportion of new HCV infections each year (5)(6)(7)(8)(9). Together with needle stick injuries or injections with contaminated syringes, especially among intravenous drug users, which constitutes the main route of infection in developed countries (10), as well as other transmission routes involving vertical and sexual transmission (11)(12)(13), approximately three to four million people are newly infected each year (14).…”

Nosocomial transmission of HCV in the liver unit of a tertiary care center

“…1,2 Transmission of HCV has been reported in individual cases related to diagnostic and therapeutic procedures, as well as in circumscribed epidemics resulting from unsafe injection practices or contaminated equipment. [3][4][5][6] Transmission of HCV by an infected health care worker is a very rare event and has been essentially linked to surgery or medical care. 7,8 Although health care-related procedures have not been unequivocally associated with HCV acquisition in case-control studies, 2 some studies have demonstrated a higher prevalence of HCV infection in patients who underwent invasive medical procedures or prolonged hospitalization.…”

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

“…In addition to clusters of HCV infections in the hemodialysis setting, cases and outbreaks of hepatitis C infection have been linked to a variety of medical procedures and interventions, including the use of spring-loaded finger stick devices (81,247), gynecological and gynecologic endocrinologic procedures (200,211,263,287), contamination of multidose vials (182,186,211,312,348,365), contaminated intravenous administration devices (299), orthopedic procedures (286), cardiothoracic surgery (41, 90, 97), anesthesiologist's and anesthesia assistant's interventions (71,143,285), endoscopy (228), colonoscopy (40), administration of contaminated immunoglobulin preparations (61, 93,171,191,192,288,317), organ transplantation (367), and outbreaks that were clearly nosocomial yet for which no etiology could be determined (178,188,290). Some, if not most, of these instances of HCV transmission most likely represent cross-contamination, due, at least in part, to inadequate infection control procedures or inadequate disinfection of devices or objects (40,81,143,186,200,211,228,247,292,299,312,348,365); others appear to be direct, provider-to-patient transmission (discussed in detail below).…”