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

  • Duc B. Nguyen (a1), Jennifer Gutowski (a2), Margherita Ghiselli (a2), Tabitha Cheng (a3), Shadia Bel Hamdounia (a2), Anil Suryaprasad (a4), Fujie Xu (a4), Heather Moulton-Meissner (a1), Tonya Hayden (a4), Joseph C. Forbi (a4), Guo-liang Xia (a4), Matthew J. Arduino (a1), Ami Patel (a2) (a5) and Priti R. Patel (a1)...

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

Copyright

Corresponding author

Address correspondence to Duc B. Nguyen, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd MS-A35, Atlanta, GA 30329-4027 (vif8@cdc.gov).

Footnotes

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

Footnotes

References

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1. Finelli, L, Miller, JT, Tokars, JI, Alter, MJ, Arduino, MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005;18:5261.
2. Armstrong, GL, Wasley, A, Simard, EP, McQuillan, GM, Kuhnert, WL, Alter, MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705714.
3. Patel, PR, Thompson, ND, Kallen, AJ, Arduino, MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis 2010;56:371378.
4. Centers for Disease Control and Prevention. Hepatitis C virus transmission at an outpatient hemodialysis unit--New York, 2001-2008. MMWR Morb Mortal Wkly Rep 2009;58:189194.
5. Thompson, ND, Novak, RT, Datta, D, et al. Hepatitis C virus transmission in hemodialysis units: importance of infection control practices and aseptic technique. Infect Control Hosp Epidemiol 2009;30:900903.
6. Forbi, JC, Campo, DS, Purdy, MA, et al. Intra-host diversity and evolution of hepatitis C virus endemic to Cote d’Ivoire. J Med Virol 2014;86:765771.
7. Girou, E, Chevaliez, S, Challine, D, et al. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Clin Infect Dis 2008;47:627633.
8. Savey, A, Simon, F, Izopet, J, Lepoutre, A, Fabry, J, Desenclos, JC. A large nosocomial outbreak of hepatitis C virus infections at a hemodialysis center. Infect Control Hosp Epidemiol 2005;26:752760.
9. Shimokura, G, Chai, F, Weber, DJ, et al. Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients. Infect Control Hosp Epidemiol 2011;32:415424.
10. Kidney Disease Improving Global Outcomes (KDIGO). Guideline 3: preventing HCV transmission in hemodialysis units. Kidney Int 2008;73:S46S52.
11. Spada, E, Abbate, I, Sicurezza, E, et al. Molecular epidemiology of a hepatitis C virus outbreak in a hemodialysis unit in Italy. J Med Virol 2008;80:261267.
12. Rao, AK, Luckman, E, Wise, ME, et al. Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies. Nephrol Nurs J 2013;40:101110, 164.
13. Thompson, ND, Novak, RT, White-Comstock, MB, et al. Patient-to-patient hepatitis C virus transmissions associated with infection control breaches in a hemodialysis unit. J Nephrol Therapeutic 2012;S10:002.
14. Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50:143.
15. Mbaeyi, C, Thompson, ND. Hepatitis C virus screening and management of seroconversions in hemodialysis facilities. Semin Dial 2013;26:439446.
16. Bergervoet, PW, van Riessen, N, Sebens, FW, van der Zwet, WC. Application of the forensic Luminol for blood in infection control. J Hosp Infect 2008;68:329333.
17. Facility Guidelines Institute. Guidelines for design and construction of healthcare facilities. Facility Guidelines Institute website. http://www.fgiguidelines.org/guidelines2010.php. Published 2010. Accessed May 2015.
18. Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee. HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002;51:145.
19. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; HICPAC. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.
20. Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion. Guide to Infection Prevention for Outpatient Settings Minimum Expectations for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion; 2011. http://www.cdc.gov/HAI/pdfs/guidelines/standatds-of-ambulatory-care-7-2011.pdf. Published 2011. Accessed May 2015.
21. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39:S134.
22. Levin, A, Rocco, M. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007;49:S10S179.
23. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48:S176S247.
24. Rutala, WA, Weber, DJ; Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008. Atlanta, GA: Centers for Disease Control and Prevention; 2008. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf. Published 2008. Accessed May 2015.
25. Sehulster, L, Chinn, RY, CDC, HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52:142.

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

  • Duc B. Nguyen (a1), Jennifer Gutowski (a2), Margherita Ghiselli (a2), Tabitha Cheng (a3), Shadia Bel Hamdounia (a2), Anil Suryaprasad (a4), Fujie Xu (a4), Heather Moulton-Meissner (a1), Tonya Hayden (a4), Joseph C. Forbi (a4), Guo-liang Xia (a4), Matthew J. Arduino (a1), Ami Patel (a2) (a5) and Priti R. Patel (a1)...

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