Observing Standard Precautions Can Help Prevent Outbreaks

Hepatitis C virus (HCV) is a leading cause of liver chronic diseases all over the world; in developed countries the highest prevalence of infection is reported among intravenous drug users and hemodialysis patients. Lanini, et al. (2010) sought to identify the pathway of HCV transmission during an outbreak of HCV infection in a privately run hemodialysis unit in Italy in 2005. Their research was published in BMC Infectious Diseases.

Dynamics of the outbreak and infection clinical outcomes were defined through an ambi-directional cohort study. Molecular epidemiology techniques were used to define the relationships between the viral variants infecting the patients and confirm the outbreak. Risk analysis and auditing procedures were carried out to define the transmission pathways.

The researchers report that of the 50 patients treated in the hemodialysis unit, five were already anti-HCV positive and 13 became positive during the study period (AR= 28.9 percent). Phylogenic analysis identified that, all the molecularly characterized incident cases (10 out of 13), were infected with the same viral variant of one of the prevalent cases. The multivariate analysis and the auditing procedure disclosed a single event of multi-dose vials heparin contamination as the cause of transmission of the infection in 11 out of the 13 incident cases; two additional incident cases occurred possibly as a result of inappropriate risk management.

Lanini, et al. (2010) say that more than 30 percent of all HCV infections in developed countries results from poor application of standard precautions during percutaneous procedures. They add that a comprehensive strategy that includes educational programs, periodical auditing on standard precaution, use of single-dose vials whenever possible, prospective surveillance for bloodborne infections (including a system of prompt notification) and risk assessment/management dedicated staff is the cornerstone to contain and prevent outbreaks in hemodialysis units.

The researchers conclude that patients undergoing dialysis are at risk for HCV infection and that HCV may be easily transmitted whenever standard precautions are not strictly applied.

Reference: Lanini S, Abbate I, Puro V, Soscia F, Albertoni F, Battisti W, Ruta A, Capobianchi MR and Ippolito G. Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome. BMC Infectious Diseases 2010, 10:257doi:10.1186/1471-2334-10-257