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Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission

Published online by Cambridge University Press:  29 August 2018

Vincent C.C. Cheng ,
Shuk-Ching Wong ,
Sally C.Y. Wong ,
Siddharth Sridhar ,
Cyril C.Y. Yip ,
Jonathan H.K. Chen ,
James Fung ,
Kelvin H.Y. Chiu ,
Pak-Leung Ho  and
Sirong Chen
...Show all authors
Vincent C.C. Cheng
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Shuk-Ching Wong
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Sally C.Y. Wong
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Siddharth Sridhar
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Cyril C.Y. Yip
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Jonathan H.K. Chen
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
James Fung
Affiliation:
Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Kelvin H.Y. Chiu
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Pak-Leung Ho
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Sirong Chen
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Ben W.C. Cheng
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Chi-Lai Ho
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Chung-Mau Lo
Affiliation:
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Kwok-Yung Yuen*
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
*
Author for correspondence: Kwok-Yung Yuen, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. E-mail: kyyuen@hku.hk
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Abstract

Background

A liver transplant recipient developed hospital-acquired symptomatic hepatitis C virus (HCV) genotype 6a infection 14 months post transplant.

Objective

Standard outbreak investigation.

Methods

Patient chart review, interviews of patients and staff, observational study of patient care practices, environmental surveillance, blood collection simulation experiments, and phylogenetic study of HCV strains using partial envelope gene sequences (E1–E2) of HCV genotype 6a strains from the suspected source patient, the environment, and the index patient were performed.

Results

Investigations and data review revealed no further cases of HCV genotype 6a infection in the transplant unit. However, a suspected source with a high HCV load was identified. HCV genotype 6a was found in a contaminated reusable blood-collection tube holder with barely visible blood and was identified as the only shared item posing risk of transmission to the index case patient. Also, 14 episodes of sequential blood collection from the source patient and the index case patient were noted on the computerized time log of the laboratory barcoding system during their 13 days of cohospitalization in the liver transplant ward. Disinfection of the tube holders was not performed after use between patients. Blood collection simulation experiments showed that HCV and technetium isotope contaminating the tip of the sleeve capping the sleeved-needle can reflux back from the vacuum-specimen tube side to the patient side.

Conclusions

A reusable blood-collection tube holder without disinfection between patients can cause a nosocomial HCV infection. Single-use disposable tube holders should be used according to the recommendations by Occupational Safety and Health Administration and World Health Organization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1170 - 1177
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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