A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic

Abstract

BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.

HCV in the haemodialysis population: Treat now or later?

“…2 A series of studies have confirmed that HCV transmission on HD reflects lack of adherence to these precautions. 3 In contrast to the prevention of hepatitis B transmission in this setting, dedicated dialysis machines for HCV-infected patients are not recommended. 4 The likelihood of HCV acquisition while on HD is increased in units with a higher background prevalence of HCV infection, so an infected HD patient also places others at risk.…”

“…In the haemodialysis (HD) population, HCV infection in part reflects acquisition of infection within dialysis units where its transmission can be effectively prevented by meticulous attention to body fluid precautions . A series of studies have confirmed that HCV transmission on HD reflects lack of adherence to these precautions . In contrast to the prevention of hepatitis B transmission in this setting, dedicated dialysis machines for HCV‐infected patients are not recommended .…”

100% Use of Infection Control Procedures in Hemodialysis Facilities

“…Inadequately cleaned and disinfected dialysis stations, priming buckets, HD machines, effluent drain wall box, and other equipment have been implicated in transmission of pathogens in HD facilities (2,3). The CDC has specific recommendations and checklists for dialysis station disinfection, which should be performed only after the patient has left the HD unit.…”

“…In addition to bacterial infections, patients on HD are also susceptible to viral infections, including hepatitis B (HBV), hepatitis C (HCV), HIV, and influenza. Outbreaks of HCV infections in HD facilities, which continue to occur with disturbing frequency, have often been due to poor infection control practices (2). In September of 2016, the Centers for Disease Control and Prevention (CDC) launched the Making Dialysis Safer for Patients Coalition to foster collaboration among dialysis organizations, physicians, public health officials, and patients.…”

CDC Urging Dialysis Providers and Facilities to Assess and Improve Infection Control Practices to Stop Hepatitis C Virus Transmission in Patients Undergoing Hemodialysis

“…Any case of new HCV infection in a patient undergoing hemodialysis is likely to be a healthcare‐associated infection and should be reported to public health authorities in a timely manner. A recent publication describes a dialysis facility where an outbreak of HCV continued for 5 years before being detected, highlighting the importance of HCV screening to identify these infections early and prevent further transmission . HCV transmission can be prevented when proper infection prevention and environmental disinfection practices are consistently followed.…”