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A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic

Published online by Cambridge University Press:  17 November 2015

Duc B. Nguyen ,
Jennifer Gutowski ,
Margherita Ghiselli ,
Tabitha Cheng ,
Shadia Bel Hamdounia ,
Anil Suryaprasad ,
Fujie Xu ,
Heather Moulton-Meissner ,
Tonya Hayden  and
Joseph C. Forbi
...Show all authors
Duc B. Nguyen*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jennifer Gutowski
Affiliation:
Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Margherita Ghiselli
Affiliation:
Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Tabitha Cheng
Affiliation:
The CDC Experience Applied Epidemiology Fellowship Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Shadia Bel Hamdounia
Affiliation:
Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Anil Suryaprasad
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Fujie Xu
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Heather Moulton-Meissner
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Tonya Hayden
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Joseph C. Forbi
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Guo-liang Xia
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew J. Arduino
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Ami Patel
Affiliation:
Philadelphia Department of Public Health, Philadelphia, Pennsylvania Office of Public Health Preparedness, Centers for Disease Control and Prevention, Atlanta, Georgia
Priti R. Patel
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Duc B. Nguyen, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd MS-A35, Atlanta, GA 30329-4027 ([email protected]).
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Abstract

BACKGROUND

In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection.

OBJECTIVE

To investigate the outbreak to identify risk factors for transmission.

METHODS

A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning.

RESULTS

Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic.

CONCLUSIONS

Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.

Infect. Control Hosp. Epidemiol. 2016;37(2):125–133

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 2 , February 2016 , pp. 125 - 133
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: 2014 Council of State and Territorial Epidemiologists Annual Conference; Nashville, TN; June 22-26, 2014 (Abstract 141).

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