title: Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks.
abstract: BACKGROUND
  Hepatitis C virus (HCV) outbreaks among patients on hemodialysis are still an important health concern all over the world.
  
  
  OBJECTIVE
  We performed a systematic review of reports on HCV outbreaks within dialysis units of developed and less-developed countries (between 1992 and 2015) to evaluate risk factors and practices associated with patient-to-patient transmission of HCV in this setting.
  
  
  METHODS
  The research was performed using the PubMed Database and the Outbreak Database; studies were selected according to the PRISMA algorithm. Inclusion criteria were established before the papers were retrieved in order to avoid selection biases.
  
  
  RESULTS
  36 papers reported on 45 outbreaks that involved 335 unique patients on maintenance hemodialysis; no fatal cases were detected. Nosocomial transmission of HCV was confirmed by phylogenetic analysis in most (n=31; 69%) reports. Sharing contaminated hemodialysis machines and multidose vials (heparin or saline solution) was suggested responsible for HCV transmission in 8 (18%) and 6 (13%) outbreaks, respectively. Breaches in environmental cleaning and disinfection practices, and failures in medication preparation and administration practices was considered in 29 (65%) outbreaks; however, the exact mechanism of transmission of HCV could not be ascertained in each facility where an outbreak occurred.
  
  
  CONCLUSIONS
  Our systematic review of reports on hepatitis C virus outbreaks shows that, although the full extent of HCV transmission in dialysis units is unknown, outbreaks continue to occur. Full compliance to standard/specific infection control procedures and routine serologic screening for HCV antibody play a pivotal role for preventing the transmission of HCV within hemodialysis units.
authors.affiliation: Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano - Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.affiliation: Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano - Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
mesh_terms: D003428:Cross Infection; D006436:Hemodialysis Units, Hospital; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D017053:Infection Control