Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit.
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.
Girou
Emmanuelle
E
Infection Control Unit, Henri Mondor Hospital, Créteil, France. emmanuelle.girou@hmn.aphp.fr
Chevaliez
Stéphane
S
Challine
Dominique
D
Thiessart
Michaël
M
Morice
Yoann
Y
Lesprit
Philippe
P
Tkoub-Scheirlinck
Latifa
L
Soing-Altrach
Sophan
S
Cizeau
Florence
F
Cavin
Celine
C
André
Martine
M
Dahmanne
Djamel
D
Lang
Philippe
P
Pawlotsky
Jean-Michel
JM
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
D012367:RNA, Viral