title: An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic.
abstract: 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.
  
  
  METHODS
  Epidemiologic analysis through a cohort study.
  
  
  METHODS
  Hematology/oncology clinic in eastern Nebraska.
  
  
  METHODS
  Patients who visited the clinic from March 2000 through December 2001.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. acq7@cdc.gov
authors.forename: Alexandre
authors.initials: A
authors.lastname: Macedo de Oliveira
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: White
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Leschinsky
authors.forename: Brady D
authors.initials: BD
authors.lastname: Beecham
authors.forename: Tara M
authors.initials: TM
authors.lastname: Vogt
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Moolenaar
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Safranek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards*; D002405:Catheterization, Central Venous / Q000592:standards; D004196:Disease Outbreaks; D004866:Equipment Contamination; D017743:Equipment Reuse; D005260:Female; D006405:Hematology; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D017053:Infection Control / Q000592:standards*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009329:Nebraska; D010045:Outpatients; D012307:Risk Factors; D012462:Saline Solution, Hypertonic; D013594:Syringes / Q000821:virology
chemical_list: D012462:Saline Solution, Hypertonic