title: Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit.
abstract: BACKGROUND
  Nosocomial transmission is the second most frequent cause of hepatitis C virus (HCV) infection. A prospective observational study was conducted to assess the roles of environmental contamination and noncompliance with standard precautions in HCV cross-transmission in a hemodialysis unit.
  
  
  METHODS
  Patients undergoing chronic hemodialysis in a French university hospital unit were systematically screened, revealing 2 sporadic cases of HCV transmission. An investigation was launched to determine whether the patients were infected in the hemodialysis unit and the possible roles of environmental contamination and noncompliance with standard precautions. We examined possible relationships among new cases of HCV infection, environmental contamination by blood and HCV RNA, and compliance with guidelines on hand hygiene and glove use.
  
  
  RESULTS
  Two patients experienced seroconversion to HCV during the study period. Phylogenetic analyses showed that 1 of these patients was infected with the same strain as that affecting a chronically infected patient also treated in the unit. Of 740 environmental surface samples, 82 (11%) contained hemoglobin; 6 (7%) of those contained HCV RNA. The rate of compliance with hand hygiene was 37% (95% confidence interval, 35%-39%), and gloves were immediately removed after patient care in 33% (95% confidence interval, 29%-37%) of cases. A low ratio of nurses to patients and poor hand hygiene were independent predictors of the presence of hemoglobin on environmental surfaces.
  
  
  CONCLUSIONS
  Blood-contaminated surfaces may be a source of HCV cross-transmission in a hemodialysis unit. Strict compliance with hand hygiene and glove use and strict organization of care procedures are needed to reduce the risk of HCV cross-transmission among patients undergoing hemodialysis.
authors.affiliation: Infection Control Unit, Henri Mondor Hospital, Créteil, France. emmanuelle.girou@hmn.aphp.fr
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Girou
authors.forename: Stéphane
authors.initials: S
authors.lastname: Chevaliez
authors.forename: Dominique
authors.initials: D
authors.lastname: Challine
authors.forename: Michaël
authors.initials: M
authors.lastname: Thiessart
authors.forename: Yoann
authors.initials: Y
authors.lastname: Morice
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesprit
authors.forename: Latifa
authors.initials: L
authors.lastname: Tkoub-Scheirlinck
authors.forename: Sophan
authors.initials: S
authors.lastname: Soing-Altrach
authors.forename: Florence
authors.initials: F
authors.lastname: Cizeau
authors.forename: Celine
authors.initials: C
authors.lastname: Cavin
authors.forename: Martine
authors.initials: M
authors.lastname: André
authors.forename: Djamel
authors.initials: D
authors.lastname: Dahmanne
authors.forename: Philippe
authors.initials: P
authors.lastname: Lang
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlotsky
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D004783:Environmental Microbiology; D005602:France / Q000453:epidemiology; D005838:Genotype; D017575:Gloves, Protective / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006235:Hand Disinfection; D006436:Hemodialysis Units, Hospital; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D006785:Hospitals, University; D006801:Humans; D010802:Phylogeny; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics
chemical_list: D012367:RNA, Viral