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Infection Control and Hospital Epidemiology
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Date Posted: Sat, November 16 2002, 9:04:32 PST
Infection Control and Hospital Epidemiology
Volume 23 (6) * June 2002
Outbreak of Hepatitis C Virus Infection in a Hemodialysis Unit: Potential Transmission by the Hemodialysis Machine?
Elisabeth Delarocque-Astagneau, MD; Nadège Baffoy, PharmD; Valérie Thiers, PhD; Nicole Simon, MD; Henriette de Valk, MD; Syria Laperche, MD; Anne-Marie Couroucé, PhD; Pascal Astagneau, MD, PhD; Claude Buisson, MD; Jean-Claude Desenclos, MD, PhD
OBJECTIVE
To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit.
DESIGN
A matched case–control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit.
SETTING
A hemodialysis unit treating an average of 90 patients.
PATIENTS
A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient.
RESULTS
HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit.
CONCLUSIONS
The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector (Infect Control Hosp Epidemiol 2002;23:328-334).
AUTHORS
Drs. Delarocque-Astagneau, de Valk, and Desenclos are from the Institut de Veille Sanitaire; Drs. Baffoy and Astagneau are from the Centre inter-régional de Coordination de la Lutte contre les Infections nosocomiales, Institut biomédical des Cordeliers; Dr. Thiers is from the Centre National de Référence pour l’épidémiologie moléculaire des hépatites virales; Dr. Simon is from the Centre de lutte contre les infections nosocomiales de l’Association pour l’Utilisation du Rein Artificiel (AURA); Dr. de Valk is from the European Programme for Intervention Epidemiology Training; and Drs. Laperche and Couroucé are from the Institut National de la Transfusion Sanguine, Paris, France.
Address reprint requests to Elisabeth Delarocque-Astagneau, InVS, 12, rue du Val d’Osne 94415 Saint-Maurice cedex, Paris, France.
The European Programme for Intervention Epidemiology Training is sponsored by the DGV of the European Commission under agreement number SOC 94 201561 05F01 (94CVVF-057-0).
www.hcop.org
Hepatitis C Outreach Project
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