摘要
Background: Approximately 2.7 million persons in the United States have chroni c hepatitis C virus (HCV) infection. Health care-associated HCV transmission ca n occur if aseptic technique is not followed. The authors suspected a health car e-associated HCV outbreak after the report of 4 HCV infections among patients a t the same hematology/oncology clinic. Objective: To determine the extent and me chanism of HCV transmission among clinic patients. Design: Epidemiologic analysi s through a cohort study. Setting: Hematology/oncology clinic in eastern Nebrask a. Participants: Patients who visited the clinic from March 2000 through December 2001. Measurements: HCV infection status, relevant medical history, and clinic -associated exposures. Bivariate analysis and logistic regression were used to identify risk factors for HCV infection. Results: Of 613 clinic patients contacted, 494 (81%) underwent HCV testing. The authors documented infection in 99 pat ients who lacked previous evidence of HCV infection; all had begun treatment at the clinic before July 2001. Hepatitis C virus genotype 3a was present in all 95 genotyped samples and presumably originated from a patient with chronic hepatit is C who began treatment in March 2000. Infection with HCV was statistically sig nificantly associated with receipt of saline flushes (P < 0.001). Shared saline bags were probably contaminated when syringes used to draw blood from venous cat heters were reused to withdraw saline solution. The clinic corrected this proced ure in July 2001. Limitation: The delay between outbreak and investigation (>1 y ear) may have contributed to an underestimate of cases. Conclusions: This large health care-associated HCV outbreak was related to shared saline bags contamina ted through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/o ncology clinics.
Background: Approximately 2.7 million persons in the United States have chroni c hepatitis C virus (HCV) infection. Health care-associated HCV transmission ca n occur if aseptic technique is not followed. The authors suspected a health car e-associated HCV outbreak after the report of 4 HCV infections among patients a t the same hematology/oncology clinic. Objective: To determine the extent and me chanism of HCV transmission among clinic patients. Design: Epidemiologic analysi s through a cohort study. Setting: Hematology/oncology clinic in eastern Nebrask a. Participants: Patients who visited the clinic from March 2000 through December 2001. Measurements: HCV infection status, relevant medical history, and clinic -associated exposures. Bivariate analysis and logistic regression were used to identify risk factors for HCV infection. Results: Of 613 clinic patients contacted, 494 (81%) underwent HCV testing. The authors documented infection in 99 pat ients who lacked previous evidence of HCV infection; all had begun treatment at the clinic before July 2001. Hepatitis C virus genotype 3a was present in all 95 genotyped samples and presumably originated from a patient with chronic hepatit is C who began treatment in March 2000. Infection with HCV was statistically sig nificantly associated with receipt of saline flushes (P < 0.001). Shared saline bags were probably contaminated when syringes used to draw blood from venous cat heters were reused to withdraw saline solution. The clinic corrected this proced ure in July 2001. Limitation: The delay between outbreak and investigation (>1 y ear) may have contributed to an underestimate of cases. Conclusions: This large health care-associated HCV outbreak was related to shared saline bags contamina ted through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/o ncology clinics.
