Hepatitis C in ward for cystic fibrosis and diabetic patients:: Possible transmission by spring-loaded finger-stick devices for self-monitoring of capillary blood glucose
Hepatitis C in ward for cystic fibrosis and diabetic patients:: Possible transmission by spring-loaded finger-stick devices for self-monitoring of capillary blood glucose
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DOI：
10.1086/501849
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发表时间：
2001-11-01
影响因子：
4.5
通讯作者：
Thiers, V
中科院分区：
文献类型：
--
作者：
Desenclos, JC;Bourdiol-Razès, M;Thiers, V
目的：确定一起医院内爆发的丙型肝炎病毒（HCV）感染的传播途径。设计：流行病学调查，包括住院患者的HCV筛查，回顾性队列研究，卫生和医疗实践回顾，以及HCV分离株的分子比较。环境：法国南部一家急症护理机构的囊性纤维化（CF）和糖尿病患者的专门护理单位。结果：57例CF患者（1995年年龄：2 ~ 28岁）中，38例（66.7%）接受检测，22例（57.9%）抗- hcv阳性。聚合酶链反应检测的16例抗hcv抗体中有8例（50%）呈病毒血症。没有患者接受过血液制品，也没有静脉注射药物的历史。所有18例（100%）CF患者曾在该单位进行过毛细血管血糖自我监测，而20例未进行过自我监测的患者中有4例（20%）为抗hcv阳性（相对风险为5.0；95%置信区间为2.1-12.0）。70例（39.5%）糖尿病患者进行了抗- hcv筛查；12例（18.8%）检测呈阳性，其中3例（25%）HCV-RNA检测呈阳性。糖尿病患者在住院期间进行常规毛细血管血糖监测，并与CF患者共享相同的弹簧触发装置进行毛细血管血糖监测。器械的一次性平台在患者使用期间没有改变。所有HCV分离株均为1型b亚型，系统发育分析显示NS5b区和E2/HVR区同源性较强。结论：正如先前报道的乙型肝炎病毒一样，共用弹簧触发的手指穿刺毛细血管血糖监测装置可能传播HCV。在任何医疗保健环境中，都必须严格执行标准预防程序。
OBJECTIVE: To identify the routes of transmission in a nosocomial outbreak of hepatitis C virus (HCV) infection.DESIGN: Epidemiological investigation, including screening for HCV of hospitalized patients, and a retrospective cohort study, review of hygiene and medical practices, and molecular comparison of HCV isolates.SETTING: A specialized care unit for cystic fibrosis (CF) and diabetic patients at an acute-care facility in the south of France.RESULTS: Of the 57 CF patients (age in 1995: 2-28 years), 38 (66.7%) were tested and 22 (57.9%) were anti-HCV positive. Eight (50%) of 16 patients with anti-HCV antibody tested by polymerase chain reaction were viremic. No patients had received blood products or had any history of intravenous drug use. All 18 (100%) patients with CF who had ever undergone self-monitoring of capillary blood glucose in the unit were anti-HCV positive, compared to 4 (20%) of 20 who had not (relative risk, 5.0; 95% confidence interval, 2.1-12.0). Seventy (39.5%) of the patients with diabetes were screened for anti-HCV; 12 (18.8%) tested positive, with 3 (25%) positive for HCV-RNA- Patients with diabetes had routine capillary blood glucose monitoring while hospitalized and shared with CF patients the same spring-triggered devices for capillary blood glucose monitoring. The disposable platform of the devices was not changed between patient use. All HCV isolates belonged to the type 1, subtype b, and phylogenetic analysis showed a close homology by sequencing of NS5b and E2/HVR regions.CONCLUSION: As reported earlier for the hepatitis B virus, shared spring-triggered devices for capillary blood glucose monitoring by finger puncture may transmit HCV. Strict application of Standard Precautions procedures is warranted in any healthcare setting.