Transmission of HIV and hepatitis C virus from a nursing home patient to a health care worker.
BACKGROUND
We report a case of simultaneous HIV and hepatitis C virus (HCV) transmission from a nursing home patient to a health care worker (HCW) whose HIV and HCV infections were diagnosed during routine blood donor screening.


METHODS
Detailed information about the HCW, possible occupational and nonoccupational blood and body fluid exposures, and possible source patient was collected. Blood samples were drawn from the HCW and patient, and HIV and HCV laboratory testing was performed at the Centers for Disease Control and Prevention.


RESULTS
The HCW, who worked as a nursing home aide, had no nonoccupational risk factors for HIV or HCV infection but provided care for 1 HIV-infected patient with dementia and urinary and fecal incontinence. The HCW had numerous exposures to the patient's emesis, feces, and urine to unprotected chapped and abraded hands. HCW and patient blood samples were positive for anti-HCV by enzyme immunoassay and recombinant immunoblot assay testing. The HCW's and patient's HCV were genotyped as 1a, and their HIV-1 was genotyped as subtype B. HIV and HCV ribonucleic acid (RNA) sequence analysis showed that the HCW's and patient's viruses were very closely related.


CONCLUSIONS
HIV and HCV transmission from the patient to the HCW appears to have occurred through nonintact skin exposure. Bloodborne pathogen transmission may have been prevented in this situation by consistent, unfailing use of barrier precautions.
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Elise M
EM
Beltrami
Anne
A
Kozak
Ian T
IT
Williams
Ae M
AM
Saekhou
Marcia L
ML
Kalish
Omana V
OV
Nainan
Susan L
SL
Stramer
Mei-Chen H
MC
Fucci
Debra
D
Frederickson
Denise M
DM
Cardo
D000328:Adult; D015658:HIV Infections / Q000635:transmission*; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D009728:Nursing Assistants; D009735:Nursing Homes; D016273:Occupational Exposure