Transmission of hepatitis C virus in an orthopedic hospital ward

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J Med Virol. 2008 Dec 23;81(2):249-257. [Epub ahead of print]

Transmission of hepatitis C virus in an orthopedic hospital ward.

Ross RS, Viazov S, Khudyakov YE, Xia GL, Lin Y, Holzmann H, Sebesta C,

Roggendorf M, Janata O.

Institute of Virology, National Reference Centre for Hepatitis C, Essen

University Hospital, University of Duisburg-Essen, Essen, Germany.

Healthcare-associated infections with hepatitis C virus (HCV) hitherto have been

observed mainly in hemodialysis settings as well as in hematology and oncology

wards. In this communication, molecular and epidemiologic investigations to

elucidate an HCV outbreak in an orthopedic ward are reported. One hundred and

thirty-five patients hospitalized in the ward and 104 staff members were tested.

In addition to extensive epidemiologic reviews and hygienic inspections, direct

sequencing of HCV PCR fragments and phylogenetic analysis of more than 300

partial HCV sequences obtained by end-point limiting-dilution real-time PCR

assay were carried out. Six patients were infected with very closely related HCV

variants. Patient-to-patient spread of the virus was inferred to have started

from one patient with previous HCV infection to the other five patients during

their hospital stay. Inspections did not reveal substantial breaches in basic

infection control practices and did not identify a specific activity that might

have led to nosocomial transmission. As a result of the investigations, the

hospital corrected the documentation of all medical and nursing activities

undertaken in the ward, abandoned the use of all multidose saline and other

medication vials, and included explicitly recommendations for the safe

preparation and administration of injectable drugs into internal infection

control guidelines. Thereafter, no further nosocomial transmissions of HCV have

been recorded in the orthopedic ward. The events observed suggest that

nosocomial transmission of HCV is not limited to hemodialysis, hematology or

oncology settings, and they also reinforce the mandatory adherence to basic

infection control practices.

J. Med. Virol. 81:249-257, 2009.

© 2008 Wiley-Liss, Inc.

PMID: 19107970 [PubMed - as supplied by publisher]