Transmission of Hepatitis C Virus from a Patient to an Anesthesiology Assistant to Five Patients

Abstract

REVENTION and treatment of infections with hepatitis C virus (HCV) remain a major challenge. 1 The main source of HCV infection in developed countries was formerly transfusion of contaminated blood and blood products but is now injection-drug use. [2][3][4] In general, a potential risk factor can be established for about 90 percent of all cases of HCV infection. 3 One way of contracting HCV may be transmission from infected medical personnel to susceptible patients during medical care. Provider-topatient transmission of HCV is rare, and in most cases HCV-positive surgeons are the probable source. 5-7 We studied an outbreak of HCV in a municipal hospital. Our findings suggest that an anesthesiology assistant contracted HCV from a chronically infected patient and subsequently transmitted the virus to five other patients. METHODS PatientsThe municipal hospital in which the HCV outbreak occurred provides general as well as specialty medical and surgical services. Between July 1 and October 13, 1998, HCV infection was diagnosed in four patients (Patients 2, 3, 4, and 6 in this report) on the basis of clinical symptoms, a rise in the serum alanine aminotransferase concentration, or detection of serum HCV antibodies and HCV RNA. All of these patients had undergone orthopedic or general surgery in the same hospital 6 to 18 weeks earlier. A comprehensive investigation was initiated by the public health authorities, and we were asked to determine the circumstances of the suspected nosocomial HCV infections. An institutional review board of Essen University Hospital approved the study protocol, and the patients provided written informed consent. Epidemiologic StudiesThe charts of all patients with HCV infection were reviewed in detail. Interviews were conducted to obtain further information about prior medical interventions, prior hepatitis infections, and P risk factors for the acquisition of HCV. To search for other potential cases of HCV transmission, we performed a retrospective seroepidemiologic study of all patients who had undergone surgery in the hospital between January and July 1998. Fifty-eight of these patients had died, and 904 were still alive; serum was obtained for antibody testing from 833 of these 904 patients. Hospital personnel were interviewed with special attention to compliance with infection-control practices and were tested for HCV antibodies. The hospital -in particular, the surgical facilities -was inspected by experts in hygiene and occupational health. Virologic and Molecular Studies

Prevention of spread of hepatitis C

“…There have been 8 documented episodes reported worldwide, 2 of which occurred in the United States. [14][15][16][17][18][19] Of those for which the mode of transmission was reported, none were associated with the performance of exposure-prone invasive procedures 14,15,[17][18][19] ; rather, most were the result of contamination of the patients' narcotics used by the health care worker for self-injection, including the 2 reported episodes in the United States. 18,19 In addition, unlike the risk for transmission of hepatitis B virus (HBV) from an infected health care worker, the risk for transmission of HCV was extremely low (averaging about 0.5%), even for those episodes involving surgeons.…”

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

“…[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. 9,10 Transmission of HCV in hemodialysis and hematology units is well documented.…”

Use of the Minimum Spanning Tree Model for Molecular Epidemiological Investigation of a Nosocomial Outbreak of Hepatitis C Virus Infection

“…Nonetheless, the nosocomial transmission of HCV continues to occur (21). Several recent studies provided evidence of patient-to-patient transmission in most of the cases of nosocomial transmission (2, 5, 6, 9, 13, 15-17, 19, 20, 29, 36), although some studies also reported transmission from health care workers to patients and vice versa (10,26,32).In recent years, the use of molecular biology techniques has proven to be a powerful tool in the epidemiological investigation of HCV infection in health care facilities and other settings (2,4,6,9,10,13,15,16,19,20,24,30,32). In particular, phylogenetic tree analysis has often been used to identify the original source of infection.…”