Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-16T05:06:52.052Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission

Published online by Cambridge University Press:  29 August 2018

Vincent C.C. Cheng ,
Shuk-Ching Wong ,
Sally C.Y. Wong ,
Siddharth Sridhar ,
Cyril C.Y. Yip ,
Jonathan H.K. Chen ,
James Fung ,
Kelvin H.Y. Chiu ,
Pak-Leung Ho  and
Sirong Chen
...Show all authors
Vincent C.C. Cheng
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Shuk-Ching Wong
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Sally C.Y. Wong
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Siddharth Sridhar
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Cyril C.Y. Yip
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Jonathan H.K. Chen
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
James Fung
Affiliation:
Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Kelvin H.Y. Chiu
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Pak-Leung Ho
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Sirong Chen
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Ben W.C. Cheng
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Chi-Lai Ho
Affiliation:
Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China
Chung-Mau Lo
Affiliation:
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Kwok-Yung Yuen*
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
*
Author for correspondence: Kwok-Yung Yuen, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

A liver transplant recipient developed hospital-acquired symptomatic hepatitis C virus (HCV) genotype 6a infection 14 months post transplant.

Objective

Standard outbreak investigation.

Methods

Patient chart review, interviews of patients and staff, observational study of patient care practices, environmental surveillance, blood collection simulation experiments, and phylogenetic study of HCV strains using partial envelope gene sequences (E1–E2) of HCV genotype 6a strains from the suspected source patient, the environment, and the index patient were performed.

Results

Investigations and data review revealed no further cases of HCV genotype 6a infection in the transplant unit. However, a suspected source with a high HCV load was identified. HCV genotype 6a was found in a contaminated reusable blood-collection tube holder with barely visible blood and was identified as the only shared item posing risk of transmission to the index case patient. Also, 14 episodes of sequential blood collection from the source patient and the index case patient were noted on the computerized time log of the laboratory barcoding system during their 13 days of cohospitalization in the liver transplant ward. Disinfection of the tube holders was not performed after use between patients. Blood collection simulation experiments showed that HCV and technetium isotope contaminating the tip of the sleeve capping the sleeved-needle can reflux back from the vacuum-specimen tube side to the patient side.

Conclusions

A reusable blood-collection tube holder without disinfection between patients can cause a nosocomial HCV infection. Single-use disposable tube holders should be used according to the recommendations by Occupational Safety and Health Administration and World Health Organization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1170 - 1177
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hajarizadeh, B, Grebely, J, Dore, GJ. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol 2013;10:553–562.Google Scholar
2. Fabrizi, F, Messa, P. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. Int J Artif Organs 2015;38:471–480.Google Scholar
3. Dolan, SA, Arias, KM, Felizardo, G, et al. APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2016;44:750–757.Google Scholar
4. Duong, CM, McLaws, ML. An investigation of an outbreak of hepatitis C virus infections in a low-resourced hemodialysis unit in Vietnam. Am J Infect Control 2016;44:560–566.Google Scholar
5. Pozzetto, B, Memmi, M, Garraud, O, Roblin, X, Berthelot, P. Healthcare-associated hepatitis C virus infection. World J Gastroenterol 2014;20:17265–17278.Google Scholar
6. Nguyen, DB, Gutowski, J, Ghiselli, M, et al. A large outbreak of hepatitis C virus infections in a hemodialysis clinic. Infect Control Hosp Epidemiol 2016;37:125–133.Google Scholar
7. Germain, JM, Carbonne, A, Thiers, V, et al. Patient-to-patient transmission of hepatitis C virus through the use of multidose vials during general anesthesia. Infect Control Hosp Epidemiol 2005;26:789–792.Google Scholar
8. Branch-Elliman, W, Weiss, D, Balter, S, Bornschlegel, K, Phillips, M. Hepatitis C transmission due to contamination of multidose medication vials: summary of an outbreak and a call to action. Am J Infect Control 2013;41:92–94.Google Scholar
9. Egro, FM, Nwaiwu, CA, Smith, S, Harper, JD, Spiess, AM. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: the University of Pittsburgh 13-year experience. Am J Infect Control 2017;45:1001–1005.Google Scholar
10. Calles, DL, Collier, MG, Khudyakov, Y, et al. Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013. Am J Infect Control 2017;45:126–132.Google Scholar
11. Yazdanpanah, Y, De Carli, G, Migueres, B, et al. Risk factors for hepatitis C virus transmission to health care workers after occupational exposure: a European case-control study. Clin Infect Dis 2005;41:1423–1430.Google Scholar
12. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organization website. http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua-1. Published 2010. Accessed April 2, 2018.Google Scholar
13. Occupational Safety and Health Administration Safety and Health Information Bulletin (SHIB 10-15-03). Study on reusable blood tube holders. National Phlebotomy Association website. http://www.nationalphlebotomy.org/896362.html. Published 2018. Accessed July 10, 2018.Google Scholar
14. Disposal of contaminated needles and blood tube holders used for phlebotomy. Safety and Health Information Bulletin. Occupational Safety and Health Administration website. www.osha.gov/dts/shib/shib101503.html. Published 2003.Google Scholar
15. Speedy Quick Release Holder Instructions for Use. Kremsmünster: Greiner Bio-one; 2017.Google Scholar
16. Usage of product: BD Vacutainer Eclipse blood collection needle with BD Vacutainer Pronto quick-release needle holder. Franklin Lakes, NJ: Becton Dickinson.Google Scholar
17. Surveillance of viral hepatitis in Hong Kong—2016 Update Report. Center for Health Protection website. https://www.chp.gov.hk/files/pdf/viral_hepatitis_report_2016_final.pdf. Published 2016. Accessed July 10, 2018.Google Scholar
18. Cheng, VC, Chan, JF, Ngan, AH, et al. Outbreak of intestinal infection due to Rhizopus microsporus . J Clin Microbiol 2009;47:2834–2843.Google Scholar
19. Cheng, VC, Wong, SS, Chen, JH, et al. An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong. Chin Med J (Engl) 2012;125:4283–4290.Google Scholar
20. Cheng, VCC, Chen, JHK, Wong, SCY, et al. Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry. Clin Infect Dis 2016;62:714–721.Google Scholar
21. Cheng, VCC, Sridhar, S, Wong, SC, et al. Japanese encephalitis virus transmitted via blood transfusion, Hong Kong, China. Emerg Infect Dis 2018:24.Google Scholar
22. Cheng, VC, Chen, JH, So, SY, et al. A novel risk factor associated with colonization by carbapenemase-producing Enterobacteriaceae: use of proton pump inhibitors in addition to antimicrobial treatment. Infect Control Hosp Epidemiol 2016;37:1418–1425.Google Scholar
23. Cheng, VC, Tai, JW, Lee, WM, et al. Infection control preparedness for human infection with influenza A H7N9 in Hong Kong. Infect Control Hosp Epidemiol 2015;36:87–92.Google Scholar
24. Cheng, VC, Tai, JW, Ng, ML, et al. Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong. Chin Med J (Engl) 2012;125:3450–3457.Google Scholar
25. Sridhar, S, Yip, CCY, Chan, JFW, To, KKW, Cheng, VCC, Yuen, KY. Impact of inter-genotypic recombination and probe cross-reactivity on the performance of the Abbott realtime HCV genotype II assay for hepatitis C genotyping. Diagn Microbiol Infect Dis 2018;91:34–37.Google Scholar
26. Manns, MP, Buti, M, Gane, E, et al. Hepatitis C virus infection. Nat Rev Dis Primers 2017;3:17006.Google Scholar
27. Valls, V, Lozano, MS, Yanez, R, et al. Use of safety devices and the prevention of percutaneous injuries among healthcare workers. Infect Control Hosp Epidemiol 2007;28:1352–1360.Google Scholar
28. Paintsil, E, Binka, M, Patel, A, Lindenbach, BD, Heimer, R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis 2014;209:1205–1211.Google Scholar
29. Ciesek, S, Friesland, M, Steinmann, J, et al. How stable is the hepatitis C virus (HCV)? Environmental stability of HCV and its susceptibility to chemical biocides. J Infect Dis 2010;201:1859–1866.Google Scholar
30. Doerrbecker, J, Meuleman, P, Kang, J, et al. Thermostability of seven hepatitis C virus genotypes in vitro and in vivo. J Viral Hepat 2013;20:478–485.Google Scholar
31. Comert, F, Aktas, E, Terzi, HA, et al. Evaluation of hepatitis C virus RNA stability in room temperature and multiple freeze–thaw cycles by COBAS AmpliPrep/COBAS TaqMan HCV. Diagn Microbiol Infect Dis 2013;75:81–85.Google Scholar
32. Girou, E, Chevaliez, S, Challine, D, et al. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Clin Infect Dis 2008;47:627–633.Google Scholar
33. Ross, RS, Viazov, S, Khudyakov, YE, et al. Transmission of hepatitis C virus in an orthopedic hospital ward. J Med Virol 2009;81:249–257.Google Scholar
Supplementary material: File

Cheng et al. supplementary material

Cheng et al. supplementary material 1

Download Cheng et al. supplementary material(File)
File 28.6 KB