Increased risk of transmission of hepatitis C in open heart surgery compared with vascular and pulmonary surgery.
BACKGROUND
We report a case of patient-to-surgeon transmission of hepatitis C virus (HCV), and the subsequent transmission of HCV to surgical patients.


METHODS
In 2007, a cardiac surgeon tested positive for hepatitis C. A complete look-back investigation was initiated that involved screening of all patients on the surgeon's operating lists between September 2004 and April 2007. Genotyping and phylogenetic analyses were performed where HCV RNA was detected.


RESULTS
Of the 499 patients invited to HCV testing, 431 responded, 13 of whom were found anti-HCV positive. One patient, who had surgery in August 2005, was found most likely to be the source of transmission to the surgeon. Of the 270 patients who had surgery after this incident, 10 became infected, giving an estimated rate of transmission of 3.7%. The HCV polymerase chain reaction positive samples were found to be the same genotype 1a strain by phylogenetic analyses. All the 10 subsequently infected patients had undergone open heart surgery, whereas none of the 103 noncardiac patients became infected, giving an estimated risk of transmission during open heart surgery of 6.0% (95% confidence interval [3.3% to 10.7%]).


CONCLUSIONS
The transmission rate from an HCV positive surgeon to patients in a cardiothoracic setting was higher than previously reported and significantly higher during open heart surgery compared with vascular and pulmonary surgery. These results indicate the need for unequivocal routines for testing and handling of HCV positive health care workers and patients.
Olsen
Karina
K
Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway. karina.olsen@unn.no
Dahl
Per Erling
PE
Paulssen
Eyvind J
EJ
Husebekk
Anne
A
Widell
Anders
A
Busund
Rolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D016174:Hepacivirus / Q000145:classification / Q000302:isolation & purification; D006526:Hepatitis C / Q000635:transmission*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D018937:Hepatitis C Antibodies; D012367:RNA, Viral