Outcome of an exercise to notify patients treated by a general surgeon infected with the hepatitis C virus

Roß, R. Stefan; Steinbrückner, Bernhard; Böhm, Stefan; Viazov, Sergei; Jilg, Wolfgang; Roggendorf, Michael

doi:10.1016/j.jcv.2008.01.006

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…Sanchez-Tapias, 1999;Massari et al, 2001;Henderson, 2003;Tallis et al, 2003;Germain et al, 2005;Prati, 2006], endoscopies and endoscopic biopsies [Bronowicki et al, 1997;Morris et al, 2006], the administration of anti-HCV and HCV RNA negative contaminated blood transfusions [Kretzschmar et al, 2007], radiopaque media [Quer et al, 2008], and the use of devices for capillary blood sampling in the context of blood sugar monitoring [Desenclos et al, 2001]. Transmission of the virus by an infected member of the medical staff [Ross and Schreier, 2007;Ross et al, 2008] was also excluded by anti-HCV screening of the hospital personnel. Therefore, the patients treated in the municipal hospital during September 2001 appeared not to have acquired HCV by any therapeutic or diagnostic procedures.…”

Section: Discussionmentioning

confidence: 99%

“…However, neither the epidemiological analyses nor the extensive hygienic reviews revealed a definite factor that led to transmission of HCV from P1 to the other five individuals. This, again, shows that, apart from the rare cases in which HCV-positive health-care workers had been the source of the infection [Ross and Schreier, 2007;Ross et al, 2008], it is difficult to identify the exact mechanisms of nosocomial HCV transmissions [Forns et al, 2005]. In this context, it should be noted that inoculation of very small amounts of blood might be sufficient to cause infections with pathogens like HCV [Chouela et al, 1996;Ross et al, 2000;Desenclos et al, 2001].…”

Section: Discussionmentioning

confidence: 99%

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Transmission of hepatitis C virus in an orthopedic hospital ward

Roß

Viazov

Khudyakov

et al. 2008

Journal of Medical Virology

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Healthcare-associated infections with hepatitis C virus (HCV) hitherto have been observed mainly in hemodialysis settings as well as in hematology and oncology wards. In this communication, molecular and epidemiologic investigations to elucidate an HCV outbreak in an orthopedic ward are reported. One hundred and thirty-five patients hospitalized in the ward and 104 staff members were tested. In addition to extensive epidemiologic reviews and hygienic inspections, direct sequencing of HCV PCR fragments and phylogenetic analysis of more than 300 partial HCV sequences obtained by end-point limiting-dilution real-time PCR assay were carried out. Six patients were infected with very closely related HCV variants. Patient-to-patient spread of the virus was inferred to have started from one patient with previous HCV infection to the other five patients during their hospital stay. Inspections did not reveal substantial breaches in basic infection control practices and did not identify a specific activity that might have led to nosocomial transmission. As a result of the investigations, the hospital corrected the documentation of all medical and nursing activities undertaken in the ward, abandoned the use of all multidose saline and other medication vials, and included explicitly recommendations for the safe preparation and administration of injectable drugs into internal infection control guidelines. Thereafter, no further nosocomial transmissions of HCV have been recorded in the orthopedic ward. The events observed suggest that nosocomial transmission of HCV is not limited to hemodialysis, hematology or oncology settings, and they also reinforce the mandatory adherence to basic infection control practices.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transmission of hepatitis C virus in an orthopedic hospital ward

Roß

Viazov

Khudyakov

et al. 2008

Journal of Medical Virology

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“…HCV transmission during surgery has been documented to occur from infected anesthesiologists (20)(21)(22), an anesthesiology assistant (23), a surgical technician (24) and surgeons (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Table 1 summarizes results of look-back exercises involving HCV-infected surgeons (2-15) with the transmission probability ranging from 0.0004 to 0.0225 per patient.…”

Section: Background On Hcv and Transmission During Surgerymentioning

confidence: 99%

“…HCV transmission from a surgeon to patients during surgery has been documented (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The purpose of the present paper is to describe the HCV look-back exercise conducted in the patients of this surgeon following his positive HCV test result.…”

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confidence: 99%

Canadian Hepatitis C Look‐Back Investigation to Detect Transmission from an Infected General Surgeon

Dawar

Stuart

Sweet³

et al. 2010

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV). The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look-back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest-risk procedures in the three years before his positive test.METHODS: Highest-risk procedures were defined as exposure-prone procedures (EPP) in which exposure to the surgeon’s blood was most likely. EPP patients from January 2004 to February 2007 were identified using hospital and administrative records. Linkages with the provincial notifiable disease for HCV was performed, and death records for deceased EPP patients were reviewed. Eligible patients were invited for screening.RESULTS: Of 6248 patients seen in phase 1, 272 (4.4%) were identified to be EPP. Of the 272 patients, 248 (91.1%) were invited for HCV testing and 24 (8.8%) were deceased. To date, 231 of 248 (93.1%) patients have presented for screening. Two patients (one alive, one deceased) were HCV positive before their EPP. Viral sequence of the surgeon’s isolate is unrelated to the first patient; the second individual has a resolved infection (polymerase chain reaction negative). No new transmission events were identified in the screened patients. The 95% CI of the transmission probability was estimated to be 0 to 0.016.INTERPRETATION: HCV transmission from the surgeon during a 38-month look back was unlikely. In the absence of protocols for investigating HCV transmission from infected health care workers, screening was initially prioritized to the highest-risk patients. The investigation has been satisfactorily terminated based on these results.

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“…More than 200 cases of health care worker-to-patient transmission of HCV have been reported in scientific publications and risk factors such as intravenous drug abuse or insufficient sanitary standard have been described. [6][7][8][9][10][11][12][13][14][15][16] Recently, a Spanish anesthetist was sentenced to 1933 years in prison for having infected 275 patients with hepatitis C. 17 Currently, there are no consistent regulations how to detect and manage HCV infected health care workers who perform exposureprone procedures (EPPs). The purpose of this article is to review the relevant published literature.…”

Section: Introductionmentioning

confidence: 99%