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Confirmation of Nosocomial Hepatitis C Virus Infection in a Hemodialysis Unit

Norihiro Furusyo , MD, PhD, Norihiko Kubo , MD, Hisashi Nakashima , MD, Kenichiro Kashiwagi , MD, Yoshitaka Etoh , BS and Jun Hayashi , MD, PhD
Infection Control and Hospital Epidemiology
Vol. 25, No. 7 (July 2004), pp. 584-590
DOI: 10.1086/502443
Stable URL:
Page Count: 7
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Confirmation of Nosocomial Hepatitis C Virus Infection in a Hemodialysis Unit
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OBJECTIVES.  To investigate a hepatitis C virus (HCV) outbreak in a hemodialysis unit and determine the source of transmission. METHODS.  We have prospectively investigated the epidemiology of hemodialysis‐related HCV infection in a single unit since 1989. In September 2000, acute hepatitis C (AH‐C) was diagnosed in 5 patients by alanine aminotransferase elevation and HCV genotype 1b viremia without antibody to HCV. We surveyed the epidemiologic situation and performed polymerase chain reaction sequence analysis of the HCV 5’‐noncoding (5’NC) region in the patients for comparison with 9 patients with chronic HCV genotype 1b viremia. RESULTS.  Sequence analysis of the 5’NC region showed the consistency in the 5 independent clones from each AH‐C patient and those from each chronic HCV viremia patient and no quasispecies over time in the clones of any of 14 analyzed patients. All AH‐C patients had the same sequencing of the 6 variations in the region with the only other patient. A saline ampoule, used for heparin solution during hemodialysis, had a recap function. It was difficult to determine whether the ampoule was new or had already been used. The source‐patient often underwent hemodialysis before the AH‐C patients and most of their hemodialysis‐related medicine was prepared during the sourcepatient’s treatment. These findings suggested a high possibility that the AH‐C patients shared a single heparin–saline solution ampoule contaminated by HCV from the source‐patient. CONCLUSION.  Nosocomial HCV infection occurred as a result of poor infection control practice when a patient with chronic HCV viremia received treatment prior to other hemodialysis patients.

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