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Outbreak of Hepatitis C Virus Infection in a Hemodialysis Unit: Potential Transmission by the Hemodialysis Machine?

  • Elisabeth Delarocque-Astagneau (a1), Nadège Baffoy (a2), Valérie Thiers (a3), Nicole Simon (a4), Henriette de Valk (a1) (a5), Syria Laperche (a6), Anne-Marie Couroucé (a6), Pascal Astagneau (a2), Claude Buisson and Jean-Claude Desenclos (a1)...
Abstract
<span class='bold'>Objective:</span>

To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit.

<span class='bold'>Design:</span>

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.

<span class='bold'>Setting:</span>

A hemodialysis unit treating an average of 90 patients.

<span class='bold'>Patients:</span>

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.

<span class='bold'>Results:</span>

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.

<span class='bold'>Conclusions:</span>

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.

Copyright
Corresponding author
InVS, 12, rue du Val d'Osne 94415 Saint-Maurice cedex, France
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. BJ Pereira , AS Levey . Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997;51:981999.

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21. A Katsoulidou , D Paraskevis , V Kalapothaki , et al. Molecular epidemiology of a hepatitis C virus outbreak in a haemodialysis unit. Nephrol Dial Transplant 1999;14:11881194.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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