Nosocomial hepatitis C in a thoracic surgery unit; retrospective findings generating a prospective study

Department of Infectious Diseases, University Hospital, Linköping, Sweden.
Journal of Hospital Infection (Impact Factor: 2.54). 05/2008; 68(4):322-8. DOI: 10.1016/j.jhin.2007.12.008
Source: PubMed


We describe the transmission of hepatitis C virus (HCV) to two patients from a thoracic surgeon who was unaware of his hepatitis C infection. By partial sequencing of the non-structural 5B gene and phylogenetic analysis, the viruses from both patients were found to be closely related to genotype 1a strain from the surgeon. Two further hepatitis C cases were found in relation to the thoracic clinic. Their HCV sequences were related to each other but were of genotype 2b and the source of infection was never revealed. To elucidate the magnitude of the problem, we conducted a prospective study for a period of 17 months in which patients who were about to undergo thoracic surgery were asked to participate. Blood samples were drawn prior to surgery and at least four months later. The postoperative samples were then screened for anti-HCV and, if positive, the initial sample was also analysed. The only two patients (0.4%) identified were confirmed anti-HCV positive before surgery, and none out of 456 evaluable cases seroconverted to anti-HCV during the observation period. Despite the retrospectively identified cases, nosocomial hepatitis C is rare in our thoracic unit. The study points out the risk of transmission of hepatitis C from infected personnel and reiterates the need for universal precautions.

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Available from: Stefan Franzen, Jan 21, 2014
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    • "The midwife involved in this case was restricted from performing exposure prone procedures and any percutaneous procedure as soon as she tested positive for hepatitis C. Both patient and midwife were offered specialist Hepatology review, counseling, and psychiatric support. The risk of transmission of hepatitis C in a healthcare setting is small, and transmission of hepatitis C from healthcare workers to patients has previously been reported only in association with exposure prone procedures, for which reported transmission rates are within the range 0% to >3% (depending on the type and frequency of exposure prone procedures performed ), and with the administration of intravenous preparations (including multi-vial drugs and heparin) [Anon., 1995; Esteban et al., 1996; Duckworth et al., 1999; Balogun et al., 2000; Lesourd et al., 2000; Ross et al., 2002, 2008; Henderson, 2003; Cardell et al., 2008; Martinez-Bauer et al., 2008; Dawar et al., 2010]. The mechanism whereby transmission occurred in the case presented here remains unclear. "
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    ABSTRACT: A woman developed acute hepatitis C (HCV) infection 2 months after delivering her baby at a London Hospital. The other patients who had been on the unit at the same time all had negative HCV serology antenatally. Testing of the healthcare workers who had been involved in this patient's care revealed that one of the midwives who only worked on the postnatal unit was chronically infected with the same viral genotype. Sequencing and phylogenetic analysis revealed close identity between the viruses from the two individuals. Although, the midwife had only performed non-exposure prone procedures including venepuncture and cannulation, our findings indicate that transmission of the virus had occurred from the healthcare worker to the patient. The potential implications of this case within the setting of national policy on blood borne viruses and healthcare workers are discussed. J. Med. Virol. © 2013 Wiley Periodicals, Inc.
    Full-text · Article · Feb 2014 · Journal of Medical Virology
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