An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic.
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.
Macedo de Oliveira
Alexandre
A
Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. acq7@cdc.gov
White
Kathryn L
KL
Leschinsky
Dennis P
DP
Beecham
Brady D
BD
Vogt
Tara M
TM
Moolenaar
Ronald L
RL
Perz
Joseph F
JF
Safranek
Thomas J
TJ
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
D012462:Saline Solution, Hypertonic