Patient-to-Patient Transmission of Hepatitis C Virus

Cancer affects almost 10 million people in the United States (1) and leads to 560 000 deaths annually (2). Survivors frequently receive chemotherapy during multiple clinic visits each year. Because of pervasive dread associated with the diagnosis of cancer in western cultures, quality of treatment is defined by the health care team's assiduous attention to detail and sensitivity to patients' emotional needs.

Imagine the astonishment, then, of vulnerable patients with cancer observing poor infection-control techniques by a health care professional attending their central venous catheters. Furthermore, consider the anguish if the patients subsequently learn that they were victims of preventable, health care–associated infections with hepatitis C virus (HCV). The virus is itself associated with a social stigma, affecting patients' relationships with sexual partners and family members (3).

In this issue, Macedo de Oliveira and colleagues document a large outbreak of hepatitis C among patients with cancer receiving chemotherapy at a freestanding clinic in Nebraska (4). An egregious practice led to the epidemic. The clinic nurse would routinely draw blood from the central venous catheters, and, after sending the specimens to the laboratory, would use the same syringe to aspirate fluid from a 500-mL saline bag and then flush the central or peripheral venous catheters of subsequent patients. Obviously, blood from a patient with hepatitis C had contaminated the common-use saline bag. The attack rate for the 367 patients studied during a 16-month period was 27%, and the statistical model of recorded data suggests that the ID₅₀ (the dose leading to infection of 50% of the exposed population) for patients at risk was 3 flushes (30 to 60 mL of saline).

The investigation from the Centers for Disease Control and Prevention clearly showed that the inadequate infection-control practices caused …