Skip to main content Accessibility help
×
Home

Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission

  • Vincent C.C. Cheng (a1) (a2), Shuk-Ching Wong (a2), Sally C.Y. Wong (a1), Siddharth Sridhar (a3), Cyril C.Y. Yip (a1), Jonathan H.K. Chen (a1), James Fung (a4), Kelvin H.Y. Chiu (a1), Pak-Leung Ho (a3), Sirong Chen (a5), Ben W.C. Cheng (a5), Chi-Lai Ho (a5), Chung-Mau Lo (a6) and Kwok-Yung Yuen (a3)...

Abstract

Background

A liver transplant recipient developed hospital-acquired symptomatic hepatitis C virus (HCV) genotype 6a infection 14 months post transplant.

Objective

Standard outbreak investigation.

Methods

Patient chart review, interviews of patients and staff, observational study of patient care practices, environmental surveillance, blood collection simulation experiments, and phylogenetic study of HCV strains using partial envelope gene sequences (E1–E2) of HCV genotype 6a strains from the suspected source patient, the environment, and the index patient were performed.

Results

Investigations and data review revealed no further cases of HCV genotype 6a infection in the transplant unit. However, a suspected source with a high HCV load was identified. HCV genotype 6a was found in a contaminated reusable blood-collection tube holder with barely visible blood and was identified as the only shared item posing risk of transmission to the index case patient. Also, 14 episodes of sequential blood collection from the source patient and the index case patient were noted on the computerized time log of the laboratory barcoding system during their 13 days of cohospitalization in the liver transplant ward. Disinfection of the tube holders was not performed after use between patients. Blood collection simulation experiments showed that HCV and technetium isotope contaminating the tip of the sleeve capping the sleeved-needle can reflux back from the vacuum-specimen tube side to the patient side.

Conclusions

A reusable blood-collection tube holder without disinfection between patients can cause a nosocomial HCV infection. Single-use disposable tube holders should be used according to the recommendations by Occupational Safety and Health Administration and World Health Organization.

Copyright

Corresponding author

Author for correspondence: Kwok-Yung Yuen, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. E-mail: kyyuen@hku.hk

References

Hide All
1. Hajarizadeh, B, Grebely, J, Dore, GJ. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol 2013;10:553562.
2. Fabrizi, F, Messa, P. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. Int J Artif Organs 2015;38:471480.
3. Dolan, SA, Arias, KM, Felizardo, G, et al. APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2016;44:750757.
4. Duong, CM, McLaws, ML. An investigation of an outbreak of hepatitis C virus infections in a low-resourced hemodialysis unit in Vietnam. Am J Infect Control 2016;44:560566.
5. Pozzetto, B, Memmi, M, Garraud, O, Roblin, X, Berthelot, P. Healthcare-associated hepatitis C virus infection. World J Gastroenterol 2014;20:1726517278.
6. Nguyen, DB, Gutowski, J, Ghiselli, M, et al. A large outbreak of hepatitis C virus infections in a hemodialysis clinic. Infect Control Hosp Epidemiol 2016;37:125133.
7. Germain, JM, Carbonne, A, Thiers, V, et al. Patient-to-patient transmission of hepatitis C virus through the use of multidose vials during general anesthesia. Infect Control Hosp Epidemiol 2005;26:789792.
8. Branch-Elliman, W, Weiss, D, Balter, S, Bornschlegel, K, Phillips, M. Hepatitis C transmission due to contamination of multidose medication vials: summary of an outbreak and a call to action. Am J Infect Control 2013;41:9294.
9. Egro, FM, Nwaiwu, CA, Smith, S, Harper, JD, Spiess, AM. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: the University of Pittsburgh 13-year experience. Am J Infect Control 2017;45:10011005.
10. Calles, DL, Collier, MG, Khudyakov, Y, et al. Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013. Am J Infect Control 2017;45:126132.
11. Yazdanpanah, Y, De Carli, G, Migueres, B, et al. Risk factors for hepatitis C virus transmission to health care workers after occupational exposure: a European case-control study. Clin Infect Dis 2005;41:14231430.
12. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organization website. http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua-1. Published 2010. Accessed April 2, 2018.
13. Occupational Safety and Health Administration Safety and Health Information Bulletin (SHIB 10-15-03). Study on reusable blood tube holders. National Phlebotomy Association website. http://www.nationalphlebotomy.org/896362.html. Published 2018. Accessed July 10, 2018.
14. Disposal of contaminated needles and blood tube holders used for phlebotomy. Safety and Health Information Bulletin. Occupational Safety and Health Administration website. www.osha.gov/dts/shib/shib101503.html. Published 2003.
15. Speedy Quick Release Holder Instructions for Use. Kremsmünster: Greiner Bio-one; 2017.
16. Usage of product: BD Vacutainer Eclipse blood collection needle with BD Vacutainer Pronto quick-release needle holder. Franklin Lakes, NJ: Becton Dickinson.
17. Surveillance of viral hepatitis in Hong Kong—2016 Update Report. Center for Health Protection website. https://www.chp.gov.hk/files/pdf/viral_hepatitis_report_2016_final.pdf. Published 2016. Accessed July 10, 2018.
18. Cheng, VC, Chan, JF, Ngan, AH, et al. Outbreak of intestinal infection due to Rhizopus microsporus . J Clin Microbiol 2009;47:28342843.
19. Cheng, VC, Wong, SS, Chen, JH, et al. An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong. Chin Med J (Engl) 2012;125:42834290.
20. Cheng, VCC, Chen, JHK, Wong, SCY, et al. Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry. Clin Infect Dis 2016;62:714721.
21. Cheng, VCC, Sridhar, S, Wong, SC, et al. Japanese encephalitis virus transmitted via blood transfusion, Hong Kong, China. Emerg Infect Dis 2018:24.
22. Cheng, VC, Chen, JH, So, SY, et al. A novel risk factor associated with colonization by carbapenemase-producing Enterobacteriaceae: use of proton pump inhibitors in addition to antimicrobial treatment. Infect Control Hosp Epidemiol 2016;37:14181425.
23. Cheng, VC, Tai, JW, Lee, WM, et al. Infection control preparedness for human infection with influenza A H7N9 in Hong Kong. Infect Control Hosp Epidemiol 2015;36:8792.
24. Cheng, VC, Tai, JW, Ng, ML, et al. Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong. Chin Med J (Engl) 2012;125:34503457.
25. Sridhar, S, Yip, CCY, Chan, JFW, To, KKW, Cheng, VCC, Yuen, KY. Impact of inter-genotypic recombination and probe cross-reactivity on the performance of the Abbott realtime HCV genotype II assay for hepatitis C genotyping. Diagn Microbiol Infect Dis 2018;91:3437.
26. Manns, MP, Buti, M, Gane, E, et al. Hepatitis C virus infection. Nat Rev Dis Primers 2017;3:17006.
27. Valls, V, Lozano, MS, Yanez, R, et al. Use of safety devices and the prevention of percutaneous injuries among healthcare workers. Infect Control Hosp Epidemiol 2007;28:13521360.
28. Paintsil, E, Binka, M, Patel, A, Lindenbach, BD, Heimer, R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis 2014;209:12051211.
29. Ciesek, S, Friesland, M, Steinmann, J, et al. How stable is the hepatitis C virus (HCV)? Environmental stability of HCV and its susceptibility to chemical biocides. J Infect Dis 2010;201:18591866.
30. Doerrbecker, J, Meuleman, P, Kang, J, et al. Thermostability of seven hepatitis C virus genotypes in vitro and in vivo. J Viral Hepat 2013;20:478485.
31. Comert, F, Aktas, E, Terzi, HA, et al. Evaluation of hepatitis C virus RNA stability in room temperature and multiple freeze–thaw cycles by COBAS AmpliPrep/COBAS TaqMan HCV. Diagn Microbiol Infect Dis 2013;75:8185.
32. 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.
33. Ross, RS, Viazov, S, Khudyakov, YE, et al. Transmission of hepatitis C virus in an orthopedic hospital ward. J Med Virol 2009;81:249257.
Type Description Title
WORD
Supplementary materials

Cheng et al. supplementary material
Cheng et al. supplementary material 1

 Word (29 KB)
29 KB

Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission

  • Vincent C.C. Cheng (a1) (a2), Shuk-Ching Wong (a2), Sally C.Y. Wong (a1), Siddharth Sridhar (a3), Cyril C.Y. Yip (a1), Jonathan H.K. Chen (a1), James Fung (a4), Kelvin H.Y. Chiu (a1), Pak-Leung Ho (a3), Sirong Chen (a5), Ben W.C. Cheng (a5), Chi-Lai Ho (a5), Chung-Mau Lo (a6) and Kwok-Yung Yuen (a3)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed