An Outbreak of Hepatitis C Virus Infections among Outpatients at a Hematology/Oncology Clinic

7 June 2005 | Volume 142 Issue 11 | Pages 898-902

Background: Approximately 2.7 million persons in the United States have chronic hepatitis C virus (HCV) infection. Health care–associated HCV transmission can occur if aseptic technique is not followed. The authors suspected a health care–associated HCV outbreak after the report of 4 HCV infections among patients at the same hematology/oncology clinic.

Objective: To determine the extent and mechanism of HCV transmission among clinic patients.

Design: Epidemiologic analysis through a cohort study.

Setting: Hematology/oncology clinic in eastern Nebraska.

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 patients 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 hepatitis C who began treatment in March 2000. Infection with HCV was statistically significantly associated with receipt of saline flushes (P < 0.001). Shared saline bags were probably contaminated when syringes used to draw blood from venous catheters were reused to withdraw saline solution. The clinic corrected this procedure in July 2001.

Limitation: The delay between outbreak and investigation (>1 year) may have contributed to an underestimate of cases.

Conclusions: This large health care–associated HCV outbreak was related to shared saline bags contaminated through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/oncology clinics.

Editors' Notes Context Hepatitis C virus (HCV) may be transmitted through health care–associated exposure involving poor aseptic technique. Contribution In an outpatient hematology/oncology clinic, 99 patients who did not have previously known HCV infection acquired the virus, apparently because a health care worker reused contaminated syringes and saline bags. Cautions Researchers may have missed some cases because the investigation occurred more than a year after the outbreak. Implications We need active, effective infection-control programs for outpatient care settings. –The Editors

 

Author and Article Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Nebraska Health and Human Services System, Lincoln, Nebraska.

Acknowledgments: The authors thank Janel Dockter, BS, and Cristina Giachetti, PhD, for their assistance in nucleic acid testing; Brett Foley, MS, for statistical support; Anne Mardis, MD, MPH, Beth Bell, MD, MPH, and Miriam Alter, PhD, MPH, for critical review of the manuscript; Alice Fournell, for logistic coordination; and Andrew Stuart and Erica Hamilton for data entry. They also thank Thomas McKnight, MD; Jean Schafersman, RN; the testing clinic staff; and most of all the clinic patients for special help in conducting this investigation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Alexandre Macedo de Oliveira, MD, MSc, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341; e-mail, acq7{at}cdc.gov.

Current Author Addresses: Dr. Macedo de Oliveira: Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341.

Mrs. White, Mr. Leschinsky, Ms. Beecham, and Dr. Safranek: Nebraska Health and Human Services System, 301 Centennial Mall South, PO Box 95007, Lincoln, NE 68509-5007.

Drs. Vogt and Perz: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-37, Atlanta, GA 30333.

Dr. Moolenaar: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-17, Atlanta, GA 30333.

Author Contributions: Conception and design: A. Macedo de Oliveira, K.L. White, T.M. Vogt, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

Analysis and interpretation of the data: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.M. Vogt, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

Drafting of the article: A. Macedo de Oliveira, K.L. White, B.D. Beecham, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

Critical revision of the article for important intellectual content: A. Macedo de Oliveira, K.L. White, B.D. Beecham, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

Final approval of the article: A. Macedo de Oliveira, K.L. White, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

Statistical expertise: K.L. White.

Obtaining of funding: T.J. Safranek.

Administrative, technical, or logistic support: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.J. Safranek.

Collection and assembly of data: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham.