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Confirmation of Nosocomial Hepatitis C Virus Infection in a Hemodialysis Unit

Published online by Cambridge University Press:  02 January 2015

Norihiro Furusyo ,
Norihiko Kubo ,
Hisashi Nakashima ,
Kenichiro Kashiwagi ,
Yoshitaka Etoh  and
Jun Hayashi
Norihiro Furusyo*
Affiliation:
Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan Department of Environmental Medicine and Infectious Disease, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
Norihiko Kubo
Affiliation:
Department of Environmental Medicine and Infectious Disease, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
Hisashi Nakashima
Affiliation:
Department of Environmental Medicine and Infectious Disease, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
Kenichiro Kashiwagi
Affiliation:
Department of Environmental Medicine and Infectious Disease, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
Yoshitaka Etoh
Affiliation:
Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan
Jun Hayashi
Affiliation:
Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan Department of Environmental Medicine and Infectious Disease, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
*
Department of General Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka, 812-8582, Japan
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Abstract

Objectives:

To investigate a hepatitis C virus (HCV) outbreak in a hemodialysis unit and determine the source of transmission.

Methods:

We have prospectively investigated the epidemiology of hemodialysis-related HCV infection in a single unit since 1989. In September 2000, acute hepatitis C (AH-C) was diagnosed in 5 patients by alanine aminotransferase elevation and HCV genotype lb viremia without antibody to HCV. We surveyed the epidemiologic situation and performed polymerase chain reaction sequence analysis of the HCV 5'-noncoding (5'NC) region in the patients for comparison with 9 patients with chronic HCV genotype 1b viremia.

Results:

Sequence analysis of the 5'NC region showed the consistency in the 5 independent clones from each AH-C patient and those from each chronic HCV viremia patient and no quasispecies over time in the clones of any of 14 analyzed patients. All AH-C patients had the same sequencing of the 6 variations in the region with the only other patient. A saline ampoule, used for heparin solution during hemodialysis, had a recap function. It was difficult to determine whether the ampoule was new or had already been used. The source-patient often underwent hemodialysis before the AH-C patients and most of their hemodialysis-related medicine was prepared during the source-patient's treatment. These findings suggested a high possibility that the AH-C patients shared a single heparin–saline solution ampoule contaminated by HCV from the source-patient.

Conclusion:

Nosocomial HCV infection occurred as a result of poor infection control practice when a patient with chronic HCV viremia received treatment prior to other hemodialysis patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 7 , July 2004 , pp. 584 - 590
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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