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

  • Gérard Krause (a1) (a2), Mary Jo Trepka (a3), Robert S. Whisenhunt (a3), Dolly Katz (a2), Omana Nainan (a4), Steven T. Wiersma (a2) and Richard S. Hopkins (a2)...



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.


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.


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.


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.


Corresponding author

Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353 Berlin, Germany


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1.Sanchez-Tapias, JM. Nosocomial transmission of hepatitis C virus. J Hepatol 1999;31(suppl 1):107112.
2.Bronowicki, JP, Venard, V, Botte, C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. NEngl J Med 1997;337:237240.
3.Schvarcz, R, Johansson, B, Nystrom, B, Sonnerborg, A. Nosocomial transmission of hepatitis C virus. Infection 1997;25:7477.
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;5:4751.
5.Cody, SH, Nainan, OV, Garfein, RS, et al. Hepatitis C virus transmission from an anesthesiologist to a patient. Arch Intern Med 2002;162:345350.
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;130:130134.
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;60:152158.
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;43:415419.
9.Esteban, JI, Gomez, J, Martell, M, et al. Transmission of hepatitis C virus by a cardiac surgeon. NEngl J Med 1996;334:555560.
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;58:139144.
11.Allander, T, Gruber, A, Naghavi, M, et al. Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward. Lancet 1995;345:603607.
12.Abulrahi, HA, Bohlega, EA, Fontaine, RE, al-Seghayer, SM, al-Ruwais, AA. Plasmodium falciparum malaria transmitted in hospital through heparin locks. Lancet 1997;349:2325.
13.Boswell, T. Internal Report on an Outbreak of Malaria. Nottingham City Hospital NHS Trust; 2000.
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;20:598603.
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;19:112113.
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;23:357363.
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):139.
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;61:127134.
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;341:556562.
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;74:23912399.
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;170:10211025.
22.Devereux, J, Haeberli, P, Smithies, O. A comprehensive set of sequence analysis programs for the VAX. Nucleic Acids Res 1984;12:387395.
23.Farci, P, Shimoda, A, Coiana, A, et al. The outcome of acute hepatitis C predicted by evolution of the viral quasispecies. Science 2000;288:339344.
24.Katzenstein, TL, Jorgensen, LB, Permin, H, et al. Nosocomial HIV-transmission in an outpatient clinic detected by epidemiological and phylogenetic analyses. AIDS 1999;13:17371744.
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;110:691698.
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;74:449456.
27.Bosch, X. Newspaper apportions blamed in Spanish hepatitis C scandal. Lancet 2000;355:818.
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;83:16891693.
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;5:165169.
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;15:9981002.
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;20:731735.
32.Gremillion, DH, Mursch, SB, Lerner, CJ. Infection site abscesses caused by Mycobacterium chelonei. Infect Control 1983;4:2528.
33.Lettau, LA. Nosocomial transmission and infection control aspects of parasitic and ectoparasitic diseases: II. Blood and tissue parasites. Infect Control Hosp Epidemiol 1991;12:111121.
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;102:476482.
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;99:330333.
36.Kohn, LT, Corrigan, JM, Donaldson, MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
37.Rutala, WA, Stiegel, MM, Sarubbi, FAJ. A potential infection hazard associated with the use of disposable saline vials. Infect Control 1984;5: 170172.
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;22:903907.


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