Hostname: page-component-788cddb947-nxk7g Total loading time: 0 Render date: 2024-10-12T09:59:34.793Z Has data issue: false hasContentIssue false
  • English
  • Français

A Large Nosocomial Outbreak of Hepatitis C Virus Infections at a Hemodialysis Center

Published online by Cambridge University Press:  21 June 2016

Anne Savey ,
Fernando Simon ,
Jacques Izopet ,
Agnès Lepoutre ,
Jacques Fabry  and
Jean-Claude Desenclos
Anne Savey*
Affiliation:
Centre Hospitalier Lyon Sud, Lyon, France
Fernando Simon
Affiliation:
from the Département Maladies Infectieuses, Institut de Veille Sanitaire, St. Maurice, France from the European Program on Intervention Epidemiology Training, Stockholm, Sweden
Jacques Izopet
Affiliation:
from the Laboratory of Virology, Centre Hospitalier Universitaire Purpan, Toulouse, France
Agnès Lepoutre
Affiliation:
from the Département Maladies Infectieuses, Institut de Veille Sanitaire, St. Maurice, France
Jacques Fabry
Affiliation:
Centre Hospitalier Lyon Sud, Lyon, France
*
Centre Hospitalier Lyon Sud, pavillon IM, F-69 495 Pierre-Benite cedex, France., anne.savey@chu-lyon.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify modes of HCV transmission during an outbreak of HCV infection in a hemodialysis unit.

Design:

An epidemiologic study, virologie analysis, assessment of infection control practices and procedures, and technical examination of products and dialysis machines.

Setting:

A private hemodialysis unit treating approximately 70 patients.

Patients:

Detection of HCV RNA by PCR was performed among patients receiving dialysis in 2001. Case-patients were patients who had a first positive result for HCV RNA between January 2001 and January 2002 and either acute hepatitis, a seroconversion for HCV antibodies, or a previous negative result. Three control-patients were randomly selected per case-patient.

Results:

Of the 61 patients treated in the unit in 2001 and not infected with HCV, 22 (36.1%) became case-patients with onset from May 2001 to January 2002 for an incidence density rate of 70 per 100 patient-years. Phylogenic analysis identified four distinct HCV groups and an index case-patient for each with a similar virus among patients already known to be infected. No multidose medication vials or material was shared between patients. Connection to a dialysis machine by a nurse who had connected an HCV-infected patient “just before” or “one patient before” increased the risk of HCV infection, whereas using the same dialysis machine after a patient infected with HCV did not. Understating, lack of training, and breaches in infection control were documented. Direct observation of practices revealed frequent flooding of blood into the double filter on the arterial pressure tubing set.

Conclusions:

During this outbreak, HCV transmission was mainly patient to patient via healthcare workers' hands. However, transmission via dialysis machines because of possible contamination of internal components could not be excluded.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 9 , September 2005 , pp. 752 - 760
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wreghitt, TG.Blood-borne virus infections in dialysis units: a review. Rev Med Virol 1999;9:101–109.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
2.Finelli, L, Miller, J. Tokars, J, Alter, M, Arduino, M.National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005;18:52–61.CrossRefGoogle ScholarPubMed
3.Schneeberger, PM, Keur, I, van Loon, AM, et al.The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study. J Infect Dis 2000;182:1291–1299.CrossRefGoogle ScholarPubMed
4.Hinrichsen, H, Leimenstoll, G, Stegen, G, Schrader, H, Folsch, UR, Schmidt, WE.Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2,796 patients. Gut 2002;51:429–433.CrossRefGoogle Scholar
5.Jadoul, M, Cornu, C, van Ypersele de Strihou, C.Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998;53:1022–1025.CrossRefGoogle ScholarPubMed
6.dos Santos, JP, Loureiro, A, Cendoroglo Neto, M, Pereira, BJ.Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant 1996;11:2017–2022.CrossRefGoogle ScholarPubMed
7.Petrosillo, N, Gilli, P, Serraino, D, et al.Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001;37:1004–1010.CrossRefGoogle ScholarPubMed
8.Jadoul, M.Epidemiology and mechanisms of transmission of the hepatitis C virus in haemodialysis. Nephrol Dial Transplant 2000;15(suppl 8):39–41.CrossRefGoogle ScholarPubMed
9.Salama, G, Rostaing, L, Sandres, K, Izopet, J.Hepatitis, Cvirus infection in French hemodialysis units: a multicenter study. J Med Virol 2000;61:44–51.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
10.de Lamballerie, X, Olmer, M, Bouchouareb, D, Zandotti, C, De Micco, P.Nosocomial transmission of hepatitis C virus in haemodialysis patients. J Med Virol 1996;49:296–302.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
11.Le Pogam, S, Le Chapois, D, Christen, R, Dubois, F, Barin, F, Goudeau, A.Hepatitis C in a hemodialysis unit: molecular evidence for nosocomial transmission. J Clin Microbiol 1998;36:3040–3043.CrossRefGoogle Scholar
12.Olmer, M, Bouchouareb, D, Zandotti, C, de Micco, P, de Lamballerie, X.Transmission of the hepatitis C virus in an hemodialysis unit: evidence for nosocomial infection. Clin Nephrol 1997;47:263–270.Google Scholar
13.Simon, N, Courouce, AM, Lemarrec, N, Trepo, C, Ducamp, S.A twelve year natural history of hepatitis C virus infection in hemodialyzed patients. Kidney Int 1994;46:504–511.CrossRefGoogle ScholarPubMed
14.Delarocque-Astagneau, E, Baffoy, N, Thiers, V, et al.Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine? Infect Control Hosp Epidemiol 2002;23:328–334.CrossRefGoogle Scholar
15.Izopet, J, Pasquier, C, Sandres, K, 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
16.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 phyloge-netic analysis. J Med Virol 2000;60:152–158.3.0.CO;2-I>CrossRefGoogle Scholar
17.Trepo, C, Pradat, P.Hepatitis C virus infection in Western Europe. J Hepatol 1999;31(suppl 1):80–83.Google Scholar
18.Hardy, N, Chiao, J, Arora, N, Mars, R, Jenkins, S.Hepatitis C virus in the hemodialysis setting: detecting viral RNA from blood port caps by reverse transcription-polymerase chain reaction. Clin Nephrol 2000;54:143–146.Google ScholarPubMed
19.Rodrigues, L, Kirkwood, BR.Case-control designs in the study of common diseases: updates on the demise of the rare disease assumption and the choice of sampling scheme for controls. Int J Epidemiol 1990;19:205–213.Google Scholar
20.Rothman, K.Epidemiology: An Introduction. Oxford: Oxford University Press; 2002:73–93.Google Scholar
21.Hosmer, D, Lemeshow, S.Applied Logistic Regression. New York: John Wiley & Sons; 1989.Google Scholar
22.Doglio, A, Laffont, C, Caroli-Bosc, FX, Rochet, P, Lefebvre, J.Second generation of the automated Cobas Amplicor HCV assay improves sensitivity of hepatitis C virus RNA detection and yields results that are more clinically relevant. J Clin Microbiol 1999;37:1567–1569.Google Scholar
23.Sandres-Saune, K, Deny, P, Pasquier, C, Thibaut, V, Duverlie, G, Izopet, J.Determining hepatitis C genotype by analyzing the sequence of the NS5b region. J Virol Methods 2003;109:187–193.CrossRefGoogle ScholarPubMed
24.Anonymous. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50(RR-5):1–43.Google Scholar
25.Fisseli, R, Bragg-Gresham, J, Woods, J, et al.Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65:2335–2342.CrossRefGoogle Scholar
26.Zampieron, A, Jayasekera, H, Elseviers, M, et al.European study on epidemiology and the management of HCV in the haemodialysis population: Part 1. Centre policy. EDTNA ERCA J 2004;30:84–90.CrossRefGoogle Scholar
27.Natov, S, Pereira, J. Routine serologic testing for hepatitis C virus infection should be instituted among dialysis patients. Semin Dial 2000;13:393–398.Google Scholar
28.Almroth, G, Ekermo, B, Mansson, A, Svensson, G, Widell, A. Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients: a long-term follow up (1989-January 1997). J Intern Med 2002;215:119–128.CrossRefGoogle Scholar
29.Pujol, FH, Ponce, JG, Lema, MG, et al.High incidence of hepatitis C virus infection in hemodialysis patients in units with high prevalence. J Clin Microbiol 1996;34:1633–1636.Google Scholar
30.Fabrizi, F, Martin, P, Dixit, V, et al.Acquisition of hepatitis C virus in hemodialysis patients: a prospective study by branched DNA signal amplification assay. Am J Kidney Dis 1998;31:647–654.CrossRefGoogle ScholarPubMed
31.Irish, DN, Blake, C, Christophers, J, et al.Identification of hepatitis C virus seroconversion resulting from nosocomial transmission on a haemodialysis unit: implications for infection control and laboratory screening. J Med Virol 1999;59:135–140.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
32.Dalekos, G, Boumba, D, Katopodis, K, et al.Absence of HCV viraemia in anti-HCV-negative haemodialysis patients. Nephrol Dial Transplant 1998;13:1804–1806.Google Scholar
33.Schneeberger, PM, Toonen, N, Keur, I, van Hamersvelt, HW.Infection control of hepatitis C in Dutch dialysis centres. Nephrol Dial Transplant 1998;13:3037–3040.Google Scholar
34.Saab, S, Brezina, M, Gitnick, G, Martin, P, Yee, HF Jr. Hepatitis C screening strategies in hemodialysis patients. Am J Kidney Dis 2001;38:91–97.Google Scholar
35.Jadoul, M.Transmission routes of HCV infection in dialysis. Nephrol Dial Transplant 1996;11(suppl 4):36–38.Google Scholar
36.Zuckerman, M.Surveillance and control of blood-borne virus infections in haemodialysis units. J Hosp Infect 2002;50:1–5.Google Scholar
37.Fabrizi, F, Martin, P, Dixit, V, et al.Detection of de novo hepatitis C virus infection by polymerase chain reaction in hemodialysis patients. Am J Nephrol 1999;19:383–388.Google Scholar
38.Tokars, JI, Frank, M, Alter, MJ, Arduino, MJ.National surveillance of dialysis-associated diseases in the United States, 2000. Semin Dial 2002;15:162–171.Google Scholar
39.European Best Practice Guidelines Expert Group on Hemodialysis, European Renal Association. Section VI. Haemodialysis-associated infection. Nephrol Dial Transplant 2002;17(suppl 7):72–87.Google Scholar
40.Jadoul, M, Cornu, C, van Ypersele de Strihou, C. Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study. The UCL Collaborative Group. Kidney Int 1993;44:1322–1326.CrossRefGoogle ScholarPubMed
41.Zeuzem, S, Scheuermann, EH, Waschk, D, et al.Phylogenetic analysis of hepatitis C virus isolates from hemodialysis patients. Kidney Int 1996;49:896–902.CrossRefGoogle ScholarPubMed
42.Keur, I, Schneeberger, PM, van der Graaf, Y, Vos, J, van Dijk, WC, van Doom, LJ. Risk factors for HCV infection in two haemodialysis units in The Netherlands. Neth J Med 1997;50:97–101.Google Scholar
43.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
44.Iwasaki, Y, Esumi, M, Hosokawa, N, Yanai, M, Kawano, K.Occasional infection of hepatitis C virus occurring in haemodialysis units identified by serial monitoring of the virus infection. J Hosp Infect 2000;45:54–61.Google Scholar
45.Kokubo, S, Horii, T, Yonekawa, O, Ozawa, N, Mukaide, M.A phyloge-netic-tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit. J Viral Hepat 2002;9:450–454.Google Scholar
46.Abacioglu, YH, Bacaksiz, F, Bahar, IH, Simmonds, P.Molecular evidence of nosocomial transmission of hepatitis C virus in a haemodialysis unit. Eur J Clin Microbiol Infect Dis 2000;19:182–186.Google Scholar
47.Norder, H, Bergstrom, A, Uhnoo, I, et al.Confirmation of nosocomial transmission of hepatitis C virus by phylogenetic analysis of the NS5-B region. J Clin Microbiol 1998;36:3066–3069.CrossRefGoogle ScholarPubMed
48.Katsoulidou, A, Paraskevis, D, Kalapothaki, V, et al.Molecular epidemiology of a hepatitis C virus outbreak in a haemodialysis unit: Multicentre Haemodialysis Cohort Study on Viral Hepatitis. Nephrol Dial Transplant 1999;14:1188–1194.CrossRefGoogle Scholar
49.Gonzalez-Candelas, F, Bracho, MA, Moya A., Molecular epidemiology and forensic genetics: application to a hepatitis C virus transmission event at a hemodialysis unit. J Infect Dis 2003;187:352–358.Google Scholar
50.Petrarulo, F, Maggi, P, Sacchetti, A, Pallotta, G, Dagostino, F, Basile, C.HCV infection occupational hazard at dialysis units and virus spread, among relatives of dialyzed patients. Nephron 1992;61:302–303.Google Scholar
51.Gilli, P, Soffritti, S, De Paoli Vitali, E, Bedani, PL.Prevention of hepatitis C virus in dialysis units. Nephron 1995;70:301–306.CrossRefGoogle ScholarPubMed
52.Saxena, AK, Panhotra, BR, Sundaram, DS, et al.Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. Am J Infect Control 2003;31:26–33.CrossRefGoogle Scholar
53.Zamir, D, Storch, S, Zonder, HB, Zamir, C, Weiner, P. Hepatitis C virus seroconversion and genotype prevalence in patients and staff on chronic hemodialysis. J Clin Gastroenterol 1999;28:23–28.CrossRefGoogle ScholarPubMed
54.Djordjevic, V, Stojanovic, K, Stojanovic, M, Stefanovic, V.Prevention of nosocomial transmission of hepatitis C infection in a hemodialysis unit: a prospective study. Int J Artif Organs 2000;23:181–188.Google Scholar
55.Harmankaya, O, Cetin, B, Obek, A, Seber, E.Low prevalence of hepatitis C virus infection in hemodialysis units: effect of isolation? Ren Fail 2002;24:639–644.CrossRefGoogle ScholarPubMed
56.Valtuille, R, Moretto, H, Lef, L, Rendo, P, Fernandez, JL. Decline of high hepatitis C virus prevalence in a hemodialysis unit with no isolation measures during a 6-year follow-up. Clin Nephrol 2002;57:371–375.Google Scholar