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Nosocomial Transmission of Hepatitis C Virus Associated With the Use of Multidose Saline Vials

Published online by Cambridge University Press:  02 January 2015

Gérard Krause ,
Mary Jo Trepka ,
Robert S. Whisenhunt ,
Dolly Katz ,
Omana Nainan ,
Steven T. Wiersma  and
Richard S. Hopkins
Gérard Krause*
Affiliation:
Epidemic Intelligence Service, State Branch, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
Mary Jo Trepka
Affiliation:
Miami-Dade County Health Department, Miami, Florida
Robert S. Whisenhunt
Affiliation:
Miami-Dade County Health Department, Miami, Florida
Dolly Katz
Affiliation:
Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
Omana Nainan
Affiliation:
Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Steven T. Wiersma
Affiliation:
Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
Richard S. Hopkins
Affiliation:
Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
*
Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353 Berlin, Germany
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Abstract

Objective:

To identify the source of an outbreak of acute hepatitis C virus (HCV) infection among 3 patients occurring within 8 weeks of hospitalization in the same ward of a Florida hospital during November 1998.

Design:

A retrospective cohort study was conducted among 41 patients hospitalized between November 11 and 19, 1998. Patients' blood was tested for antibodies to HCV, and HCV RNA-positive samples were genotyped and sequenced.

Results:

Of the 41 patients, 24 (59%) participated in the study. HCV genotype 1b infections were found in 5 patients. Three of 4 patients who received saline flushes from a multidose saline vial on November 16 had acute HCV infection, whereas none of the 9 patients who did not receive saline flushes had HCV infection (P = .01). No other significant exposures were identified. The HCV sequence was available for 1 case of acute HCV and differed by a single nucleotide (0.3%) from that of the indeterminate case.

Conclusion:

This outbreak of HCV probably occurred when a multidose saline vial was contaminated with blood from an HCV-infected patient. Hospitals should emphasize adherence to standard procedures to prevent blood-borne infections. In addition, the use of single-dose vials or prefilled saline syringes might further reduce the risk for nosocomial transmission of blood-borne pathogens.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 2 , February 2003 , pp. 122 - 127
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Sanchez-Tapias, JM. Nosocomial transmission of hepatitis C virus. J Hepatol 1999;31(suppl 1):107–112.CrossRefGoogle ScholarPubMed
2.Bronowicki, JP, Venard, V, Botte, C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. NEngl J Med 1997;337:237–240.Google Scholar
3.Schvarcz, R, Johansson, B, Nystrom, B, Sonnerborg, A. Nosocomial transmission of hepatitis C virus. Infection 1997;25:74–77.Google Scholar
4.Chant, K, Kociuba, K, Munro, R, et al. Investigation of possible patient-to-patient transmission of hepatitis C in a hospital. New South Wales Public Health Bulletin 1994;5:47–51.Google Scholar
5.Cody, SH, Nainan, OV, Garfein, RS, et al. Hepatitis C virus transmission from an anesthesiologist to a patient. Arch Intern Med 2002;162:345–350.Google Scholar
6.Widell, A. Christensson, B, Wiebe, T, Hansson, HB, Allander, T, Persson, MA. Epidemiologic and molecular investigation of outbreaks of hepatitis C virus infection on a pediatric oncology service. Ann Intern Med 1999;130:130–134.Google Scholar
7.Grethe, S, Gemsa, F, Monazahian, M, Bohme, I, Uy, A. Thomssen, R. Molecular epidemiology of an outbreak of HCV in a hemodialysis unit: direct sequencing of HCV-HVR1 as an appropriate tool for phylogenetic analysis. J Med Virol 2000;60:152–158.Google Scholar
8.Allander, T, Medin, C, Jacobson, SH, Grillner, L, Persson, MA. Hepatitis C transmission in a hemodialysis unit: molecular evidence for spread of virus among patients not sharing equipment. J Med Virol 1994;43:415–419.CrossRefGoogle Scholar
9.Esteban, JI, Gomez, J, Martell, M, et al. Transmission of hepatitis C virus by a cardiac surgeon. NEngl J Med 1996;334:555–560.Google Scholar
10.Izopet, J, Pasquier, C, Sandres, J, Puel, J, Rostaing, L. Molecular evidence for nosocomial transmission of hepatitis C virus in a French hemodialysis unit. J Med Virol 1999;58:139–144.Google Scholar
11.Allander, T, Gruber, A, Naghavi, M, et al. Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward. Lancet 1995;345:603–607.Google Scholar
12.Abulrahi, HA, Bohlega, EA, Fontaine, RE, al-Seghayer, SM, al-Ruwais, AA. Plasmodium falciparum malaria transmitted in hospital through heparin locks. Lancet 1997;349:23–25.Google Scholar
13.Boswell, T. Internal Report on an Outbreak of Malaria. Nottingham City Hospital NHS Trust; 2000.Google Scholar
14.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598–603.Google Scholar
15.van Laer, F, Raes, D, Vandamme, P, et al. An outbreak of Burkholderia cepacia with septicemia on a cardiology ward. Infect Control Hosp Epidemiol 1998;19:112–113.Google Scholar
16.Chodoff, A, Pettis, AM, Schoonmaker, D, Shelly, MA. Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous system. Am J Infect Control 1995;23:357–363.Google Scholar
17.Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(RR-19):1–39.Google Scholar
18.Nainan, OV, Cromeans, TL, Margolis, HS. Sequence-specific, single-primer amplification and detection of PCR products for identification of hepatitis viruses. J Virol Methods 1996;61:127–134.CrossRefGoogle ScholarPubMed
19.Alter, MJ, Kruszon-Moran, D, Nainan, OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999;341:556–562.Google Scholar
20.Simmonds, P, Holmes, EC, Cha, TA. et al. Classification of hepatitis C virus into six major genotypes and a series of subtypes by phylogenetic analysis of the NS-5 region. J Gen Virol 1993;74:2391–2399.Google Scholar
21.Enomoto, N, Takada, A, Nakao, T, Date, T. There are two major types of hepatitis C virus in Japan. Biochem Biophys Res Commun 1990;170:1021–1025.Google Scholar
22.Devereux, J, Haeberli, P, Smithies, O. A comprehensive set of sequence analysis programs for the VAX. Nucleic Acids Res 1984;12:387–395.Google Scholar
23.Farci, P, Shimoda, A, Coiana, A, et al. The outcome of acute hepatitis C predicted by evolution of the viral quasispecies. Science 2000;288:339–344.CrossRefGoogle ScholarPubMed
24.Katzenstein, TL, Jorgensen, LB, Permin, H, et al. Nosocomial HIV-transmission in an outpatient clinic detected by epidemiological and phylogenetic analyses. AIDS 1999;13:1737–1744.Google Scholar
25.Oren, I, Hershow, RC, Ben-Porath, E, et al. A common-source outbreak of fulminant hepatitis B in a hospital. Ann Intern Med 1989;110:691–698.Google Scholar
26.Kantor, RJ, Carson, LA, Graham, DR. Outbreak of pyrogenic reactions at a dialysis center: association with infusion of heparinized saline solution. Am J Med 1983;74:449–456.Google Scholar
27.Bosch, X. Newspaper apportions blamed in Spanish hepatitis C scandal. Lancet 2000;355:818.Google Scholar
28.Hlady, WG, Hopkins, RS, Ogilby, TE, Allen, ST. Patient-to-patient transmission of hepatitis B in a dermatology practice. Am J Public Health 1993;83:1689–1693.Google Scholar
29.Longfield, R, Longfield, J, Smith, LP, Hyams, KC, Strohmer, ME. Multidose medication vial sterility: an in-use study and a review of the literature. Infect Control 1984;5:165–169.Google Scholar
30.Welbel, SF, McNeil, MM, Kuykendall, RJ, et al. Candida parapsilosis bloodstream infections in neonatal intensive care unit patients: epidemiologic and laboratory confirmation of a common source outbreak. Pediatr Infect Dis J 1996;15:998–1002.Google Scholar
31.Hutin, YJ, Goldstein, ST, Varma, JK, et al. An outbreak of hospital-acquired hepatitis B virus infection among patients receiving chronic hemodialysis. Infect Control Hosp Epidemiol 1999;20:731–735.Google Scholar
32.Gremillion, DH, Mursch, SB, Lerner, CJ. Infection site abscesses caused by Mycobacterium chelonei. Infect Control 1983;4:25–28.Google Scholar
33.Lettau, LA. Nosocomial transmission and infection control aspects of parasitic and ectoparasitic diseases: II. Blood and tissue parasites. Infect Control Hosp Epidemiol 1991;12:111–121.Google Scholar
34.Navarro, P, Betancurt, A, Paublini, H, et al. Malaria causada por Plasmodium falciparum como infeccion nosocomial [Plasmodium falciparum malaria as a nosocomial infection]. Boletin de la Oficina Sanitaria Panamericana 1987;102:476–482.Google Scholar
35.Alter, MJ, Ahtone, J, Maynard, JE. Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit. Ann Intern Med 1983;99:330–333.Google Scholar
36.Kohn, LT, Corrigan, JM, Donaldson, MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.Google Scholar
37.Rutala, WA, Stiegel, MM, Sarubbi, FAJ. A potential infection hazard associated with the use of disposable saline vials. Infect Control 1984;5: 170–172.Google Scholar
38.McNeil, MM, Solomon, SL, Anderson, RL, et al. Nosocomial Pseudomonas pickettii colonization associated with a contaminated respiratory therapy solution in a special care nursery. J Clin Microbiol 1985;22:903–907.Google Scholar