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Iatrogenic Hepatitis C Virus Infection

Two reports highlight the importance of infection control precautions during routine procedures.

Health care–associated hepatitis C virus (HCV) transmission is possible, although universal precautions and aseptic techniques should minimize risks. In two reports, researchers address these risks in different practice settings.

A gastroenterologist reported four cases of HCV genotype-3a infection in patients who attended a single hematology/oncology clinic. Of 370 patients cared for at the clinic by one registered nurse who later was dismissed because of breaches in infection-control practices, 99 patients without prior HCV infection tested positive for HCV antibodies; 96% of cases had genotype 3a (genotype could not be determined in the remaining 4 cases). Patients reported that the nurse reused syringes to withdraw saline for catheter flushes after using them for blood draws.

In the second report, researchers studied 9008 people without HCV infection who had undergone endoscopy at three centers in Italy where disinfection routinely was done in accordance with international guidelines. Six months after the procedure, HCV antibody tests remained negative in all 8260 people who were followed. Similarly, risk was zero for the 912 people who had undergone endoscopy with an endoscope that had been used earlier that day for an HCV-positive patient.

Comment: The first case seems so egregious as to be unlikely. Nonetheless, it happened, and it led to HCV infection in almost one third of patients at a hematology/oncology clinic. This outbreak shows that attention to quality of care during routine procedures must be ongoing. Although the second report reassures us that endoscopy is extremely unlikely to transmit HCV, the findings do not completely rule out the possibility of rare transmission.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine July 5, 2005

Citation(s):

Macedo de Oliveira A et al. An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic. Ann Intern Med 2005 Jun 7; 142:898-902.

• Original article (Subscription may be required)
• Medline abstract (Free)

Ciancio A et al. Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus. Ann Intern Med 2005 Jun 7; 142:903-9.

• Original article (Subscription may be required)
• Medline abstract (Free)