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A Large Nosocomial Outbreak of Hepatitis C Virus Infections at a Hemodialysis Center

  • Anne Savey (a1), Fernando Simon (a2) (a3), Jacques Izopet (a4), Agnès Lepoutre (a2), Jacques Fabry (a1) and Jean-Claude Desenclos...
Abstract</title><sec id='abs1'><title>Objective:</title><p>To identify modes of HCV transmission during an outbreak of HCV infection in a hemodialysis unit.</p></sec><sec id='abs2'><title>Design:</title><p>An epidemiologic study, virologie analysis, assessment of infection control practices and procedures, and technical examination of products and dialysis machines.</p></sec><sec id='abs3'><title>Setting:</title><p>A private hemodialysis unit treating approximately 70 patients.</p></sec><sec id='abs4'><title>Patients:</title><p>Detection of HCV RNA by PCR was performed among patients receiving dialysis in 2001. Case-patients were patients who had a first positive result for HCV RNA between January 2001 and January 2002 and either acute hepatitis, a seroconversion for HCV antibodies, or a previous negative result. Three control-patients were randomly selected per case-patient.</p></sec><sec id='abs5'><title>Results:</title><p>Of the 61 patients treated in the unit in 2001 and not infected with HCV, 22 (36.1%) became case-patients with onset from May 2001 to January 2002 for an incidence density rate of 70 per 100 patient-years. Phylogenic analysis identified four distinct HCV groups and an index case-patient for each with a similar virus among patients already known to be infected. No multidose medication vials or material was shared between patients. Connection to a dialysis machine by a nurse who had connected an HCV-infected patient “just before” or “one patient before” increased the risk of HCV infection, whereas using the same dialysis machine after a patient infected with HCV did not. Understating, lack of training, and breaches in infection control were documented. Direct observation of practices revealed frequent flooding of blood into the double filter on the arterial pressure tubing set.</p></sec><sec id='abs6'><title>Conclusions:
AbstractObjective:

To identify modes of HCV transmission during an outbreak of HCV infection in a hemodialysis unit.

Design:

An epidemiologic study, virologie analysis, assessment of infection control practices and procedures, and technical examination of products and dialysis machines.

Setting:

A private hemodialysis unit treating approximately 70 patients.

Patients:

Detection of HCV RNA by PCR was performed among patients receiving dialysis in 2001. Case-patients were patients who had a first positive result for HCV RNA between January 2001 and January 2002 and either acute hepatitis, a seroconversion for HCV antibodies, or a previous negative result. Three control-patients were randomly selected per case-patient.

Results:

Of the 61 patients treated in the unit in 2001 and not infected with HCV, 22 (36.1%) became case-patients with onset from May 2001 to January 2002 for an incidence density rate of 70 per 100 patient-years. Phylogenic analysis identified four distinct HCV groups and an index case-patient for each with a similar virus among patients already known to be infected. No multidose medication vials or material was shared between patients. Connection to a dialysis machine by a nurse who had connected an HCV-infected patient “just before” or “one patient before” increased the risk of HCV infection, whereas using the same dialysis machine after a patient infected with HCV did not. Understating, lack of training, and breaches in infection control were documented. Direct observation of practices revealed frequent flooding of blood into the double filter on the arterial pressure tubing set.

Conclusions:

During this outbreak, HCV transmission was mainly patient to patient via healthcare workers' hands. However, transmission via dialysis machines because of possible contamination of internal components could not be excluded.

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Corresponding author
Centre Hospitalier Lyon Sud, pavillon IM, F-69 495 Pierre-Benite cedex, France., anne.savey@chu-lyon.fr
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1. TG. Wreghitt Blood-borne virus infections in dialysis units: a review. Rev Med Virol 1999;9:101109.

2. L Finelli , J Miller . J Tokars , M Alter , M. Arduino National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005;18:5261.

3. PM Schneeberger , I Keur , AM van Loon , et al.The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study. J Infect Dis 2000;182:12911299.

4. H Hinrichsen , G Leimenstoll , G Stegen , H Schrader , UR Folsch , WE. Schmidt Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2,796 patients. Gut 2002;51:429433.

5. M Jadoul , C Cornu , C. van Ypersele de Strihou Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998;53:10221025.

6. JP dos Santos , A Loureiro , M Cendoroglo Neto , BJ. Pereira Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant 1996;11:20172022.

7. N Petrosillo , P Gilli , D Serraino , et al.Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001;37:10041010.

8. M. Jadoul Epidemiology and mechanisms of transmission of the hepatitis C virus in haemodialysis. Nephrol Dial Transplant 2000;15(suppl 8):3941.

9. G Salama , L Rostaing , K Sandres , J. Izopet C Hepatitis virus infection in French hemodialysis units: a multicenter study. J Med Virol 2000;61:4451.

10. X de Lamballerie , M Olmer , D Bouchouareb , C Zandotti , P. De Micco Nosocomial transmission of hepatitis C virus in haemodialysis patients. J Med Virol 1996;49:296302.

13. N Simon , AM Courouce , N Lemarrec , C Trepo , S. Ducamp A twelve year natural history of hepatitis C virus infection in hemodialyzed patients. Kidney Int 1994;46:504511.

14. E Delarocque-Astagneau , N Baffoy , V Thiers , et al.Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine? Infect Control Hosp Epidemiol 2002;23:328334.

15. J Izopet , C Pasquier , K Sandres , J Puel , L. Rostaing Molecular evidence for nosocomial transmission of hepatitis C virus in a French hemodialysis unit. J Med Virol 1999;58:139144.

16. S Grethe , F Gemsa , M Monazahian , I Bohme , A Uy , R. Thomssen Molecular epidemiology of an outbreak of HCV in a hemodialysis unit: direct sequencing of HCV-HVR1 as an appropriate tool for phyloge-netic analysis. J Med Virol 2000;60:152158.

17. C Trepo , P. Pradat Hepatitis C virus infection in Western Europe. J Hepatol 1999;31(suppl 1):8083.

19. L Rodrigues , BR. Kirkwood Case-control designs in the study of common diseases: updates on the demise of the rare disease assumption and the choice of sampling scheme for controls. Int J Epidemiol 1990;19:205213.

23. K Sandres-Saune , P Deny , C Pasquier , V Thibaut , G Duverlie , J. Izopet Determining hepatitis C genotype by analyzing the sequence of the NS5b region. J Virol Methods 2003;109:187193.

25. R Fisseli , J Bragg-Gresham , J Woods , et al.Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65:23352342.

26. A Zampieron , H Jayasekera , M Elseviers , et al.European study on epidemiology and the management of HCV in the haemodialysis population: Part 1. Centre policy. EDTNA ERCA J 2004;30:8490.

27. S Natov , J Pereira . Routine serologic testing for hepatitis C virus infection should be instituted among dialysis patients. Semin Dial 2000;13:393398.

30. F Fabrizi , P Martin , V Dixit , et al.Acquisition of hepatitis C virus in hemodialysis patients: a prospective study by branched DNA signal amplification assay. Am J Kidney Dis 1998;31:647654.

31. DN Irish , C Blake , J Christophers , et al.Identification of hepatitis C virus seroconversion resulting from nosocomial transmission on a haemodialysis unit: implications for infection control and laboratory screening. J Med Virol 1999;59:135140.

32. G Dalekos , D Boumba , K Katopodis , et al.Absence of HCV viraemia in anti-HCV-negative haemodialysis patients. Nephrol Dial Transplant 1998;13:18041806.

33. PM Schneeberger , N Toonen , I Keur , HW. van Hamersvelt Infection control of hepatitis C in Dutch dialysis centres. Nephrol Dial Transplant 1998;13:30373040.

34. S Saab , M Brezina , G Gitnick , P Martin , HF Yee Jr. Hepatitis C screening strategies in hemodialysis patients. Am J Kidney Dis 2001;38:9197.

35. M. Jadoul Transmission routes of HCV infection in dialysis. Nephrol Dial Transplant 1996;11(suppl 4):3638.

36. M. Zuckerman Surveillance and control of blood-borne virus infections in haemodialysis units. J Hosp Infect 2002;50:15.

37. F Fabrizi , P Martin , V Dixit , et al.Detection of de novo hepatitis C virus infection by polymerase chain reaction in hemodialysis patients. Am J Nephrol 1999;19:383388.

38. JI Tokars , M Frank , MJ Alter , MJ. Arduino National surveillance of dialysis-associated diseases in the United States, 2000. Semin Dial 2002;15:162171.

40. M Jadoul , C Cornu , C van Ypersele de Strihou . Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study. The UCL Collaborative Group. Kidney Int 1993;44:13221326.

41. S Zeuzem , EH Scheuermann , D Waschk , et al.Phylogenetic analysis of hepatitis C virus isolates from hemodialysis patients. Kidney Int 1996;49:896902.

42. I Keur , PM Schneeberger , Y van der Graaf , J Vos , WC van Dijk , LJ van Doom . Risk factors for HCV infection in two haemodialysis units in The Netherlands. Neth J Med 1997;50:97101.

43. T Allander , C Medin , SH Jacobson , L Grillner , MA. Persson Hepatitis C transmission in a hemodialysis unit: molecular evidence for spread of virus among patients not sharing equipment. J Med Virol 1994;43:415419.

44. Y Iwasaki , M Esumi , N Hosokawa , M Yanai , K. Kawano Occasional infection of hepatitis C virus occurring in haemodialysis units identified by serial monitoring of the virus infection. J Hosp Infect 2000;45:5461.

45. S Kokubo , T Horii , O Yonekawa , N Ozawa , M. Mukaide A phyloge-netic-tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit. J Viral Hepat 2002;9:450454.

46. YH Abacioglu , F Bacaksiz , IH Bahar , P. Simmonds Molecular evidence of nosocomial transmission of hepatitis C virus in a haemodialysis unit. Eur J Clin Microbiol Infect Dis 2000;19:182186.

48. A Katsoulidou , D Paraskevis , V Kalapothaki , et al.Molecular epidemiology of a hepatitis C virus outbreak in a haemodialysis unit: Multicentre Haemodialysis Cohort Study on Viral Hepatitis. Nephrol Dial Transplant 1999;14:11881194.

49. F Gonzalez-Candelas , MA Bracho , Moya A. Molecular epidemiology and forensic genetics: application to a hepatitis C virus transmission event at a hemodialysis unit. J Infect Dis 2003;187:352358.

50. F Petrarulo , P Maggi , A Sacchetti , G Pallotta , F Dagostino , C. Basile HCV infection occupational hazard at dialysis units and virus spread, among relatives of dialyzed patients. Nephron 1992;61:302303.

51. P Gilli , S Soffritti , E De Paoli Vitali , PL. Bedani Prevention of hepatitis C virus in dialysis units. Nephron 1995;70:301306.

52. AK Saxena , BR Panhotra , DS Sundaram , et al.Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. Am J Infect Control 2003;31:2633.

55. O Harmankaya , B Cetin , A Obek , E. Seber Low prevalence of hepatitis C virus infection in hemodialysis units: effect of isolation? Ren Fail 2002;24:639644.

56. R Valtuille , H Moretto , L Lef , P Rendo , JL Fernandez . Decline of high hepatitis C virus prevalence in a hemodialysis unit with no isolation measures during a 6-year follow-up. Clin Nephrol 2002;57:371375.

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Infection Control & Hospital Epidemiology
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