Approximately 3 million persons in the United States have chronic Hepatitis C virus infection.
Health care–associated Hepatitis C transmission can occur if aseptic technique is not followed.
Dr de Oliveira and colleagues suspected a health care–associated Hepatitis C outbreak after 4 infections among patients at the same clinic.
The investigators determined the extent and mechanism of Hepatitis C transmission among clinic patients by an epidemiologic analysis through a cohort study.
The investigative team included patients who visited the haematology/oncology clinic in Nebraska from 2000 through 2001.
|Contaminated probably occurred when syringes for drawing blood were reused to withdraw saline solution from shared bags|
|Annals of Internal Medicine|
The team measured Hepatitis C infection status, relevant medical history, and clinic-associated exposures.
The investigators used bivariate analysis and logistic regression to identify risk factors for Hepatitis C infection.
Of 613 clinic patients contacted, the team reported that 494 underwent Hepatitis C testing.
The investigators documented infection in 99 patients who lacked previous evidence of Hepatitis C infection; all had begun treatment at the clinic before 2001.
The team identified Hepatitis C virus genotype 3a in all 95 genotyped samples.
The infection presumably originated from a patient with chronic Hepatitis C who began treatment in 2000.
The investigators found that infection with Hepatitis C was statistically significantly associated with receipt of saline flushes.
The team suggested that shared saline bags were probably contaminated when syringes used to draw blood from venous catheters were reused to withdraw saline solution.
The clinic corrected the procedure of saline flushes in July 2001.
The investigators noted that the delay of more than a year between outbreak and investigation may have contributed to an underestimate of cases.
Dr de Oliveira's team concludes, “This large health care–associated Hepatitis C outbreak was related to shared saline bags contaminated through syringe reuse.”
“Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/oncology clinics.”