Preventing iatrogenic HCV infection: A quantitative risk assessment based on observational data in an Egyptian hospital

Abstract

When compliance with infection control recommendations is non-optimal, hospitals may play an important role in hepatitis C (HCV) transmission. However, few studies have analysed HCV acquisition risk based on detailed empirical data in order to identify high-risk patient profiles or transmission hotspots. We used data from a prospective cohort study conducted on 500 patients in the internal medicine and surgery departments of Ain Shams hospital (Cairo, Egypt). We first performed a sequence analysis to describe patient trajectory profiles. Second, we estimated each patient individual risk of HCV acquisition based on ward-specific prevalence and procedures undergone. We then identified within-hospital risk hotspots by computing ward-level risks. A beta regression model was used to highlight upon-admission factors linked to HCV acquisition risk. Finally, ward-focused and patient-focused strategies were assessed for their ability to reduce HCV infection risk. Sequence analysis identified 4 distinct patient profiles. The estimated HCV acquisition risk varied widely between patients and patient profiles. The risk was found to be higher in the internal medicine hospital compared to the surgery hospital (median: 0.188% IQR [0.142%-0.235%] vs. 0.043%, CI 95%: [0.036%-0.050%]). Upon-admission risk predictors included source of admission, age, reason for hospitalization, and history of anti-schistosomiasis treatment, injection and endoscopy. Patient-focused interventions were found to be most effective to reduce HCV infection risk. Our results might help reduce the risk of HCV acquisition during hospitalisation in Egypt by targeting enhanced control measures to ward-level transmission hotspots and to at-risk patients identified upon admission.

An agent-based model to simulate the transmission dynamics of bloodborne pathogens within hospitals

“…Various sources of uncertainty might have interfered with the per-procedure risk estimations. In particular, the risk associated with surgery was estimated based on ORs reported in multiple studies (3), but no information was available on whether this procedure was describing the procedure itself or took into account surgeries and other often associated subprocedures (such as intubation or injection for example) as a whole. Thus, a sensitivity analysis was performed in order to compare our baseline assumption (i.e., that this risk is in fact associated with the act of surgery itself) with the alternative assumption that this risk also accounts for other sub-procedures associated with surgery, in which case we excluded from our database all procedures occurring in the operating room (OR) except the ones reported as surgeries.…”

“…Nevertheless, iatrogenic transmission may occur during invasive procedures when compliance to infection control measures is imperfect. Recent studies have highlighted the persisting increased risk of HBV and HCV infection in individuals exposed to invasive procedures, with high risk levels in some low-or middle-income countries (2,3).…”