An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic
An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic
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DOI：
10.7326/0003-4819-142-11-200506070-00007
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发表时间：
2005-06-07
影响因子：
39.2
通讯作者：
Safranek, TJ
中科院分区：
文献类型：
--
作者：
de Oliveira, AM;White, KL;Safranek, TJ
背景：美国约有270万人患有慢性丙型肝炎病毒（HCV）感染。如果不遵循无菌技术，可能会发生与卫生保健相关的HCV传播。在同一血液学/肿瘤学诊所报告了4例HCV感染患者后，作者怀疑与卫生保健相关的HCV爆发。目的：确定诊所患者中HCV传播的程度和机制。设计：通过队列研究进行流行病学分析。设置：内布拉斯加州东部的血液学/肿瘤学诊所。参与者：从2000年3月到2001年12月到诊所就诊的患者。测量：HCV感染状态，相关病史和临床相关暴露。结果：613例门诊患者中，494例（81%）进行了HCV检测。作者记录了99名既往缺乏丙型肝炎病毒感染证据的患者的感染情况;所有人都在2001年7月之前开始在诊所接受治疗。丙型肝炎病毒基因型3a存在于所有95个基因分型样本中，推测其起源于2000年3月开始治疗的慢性丙型肝炎患者。HCV感染与接受生理盐水冲洗显著相关（P <0.001）。当用于从静脉导管中抽血的注射器被重复用于抽取盐水溶液时，共用的盐水袋可能被污染。该诊所于2001年7月纠正了这一程序。局限性：爆发和调查之间的延迟（> 1年）可能导致低估了cases.Conclusions：这一大型卫生保健相关的HCV爆发与通过注射器重复使用而污染的共用盐水袋有关。需要有效的感染控制计划，以确保血液学/肿瘤学诊所等门诊医疗设施的高标准护理。
Background: Approximately 2.7 million persons in the United States have chronic hepatitis C virus (HCV) infection. Health care-associated HCV transmission can occur if aseptic technique is not followed. The authors suspected a health care-associated HCV outbreak after the report of 4 HCV infections among patients at the same hematology/oncology clinic.Objective: To determine the extent and mechanism of HCV transmission among clinic patients.Design: Epidemiologic analysis through a cohort study.Setting: Hematology/oncology clinic in eastern Nebraska.Participants: Patients who visited the clinic from March 2000 through December 2001.Measurements: HCV infection status, relevant medical history, and clinic-associated exposures. Bivariate analysis and logistic regression were used to identify risk factors for HCV infection.Results: Of 613 clinic patients contacted, 494 (81%) underwent HCV testing. The authors documented infection in 99 patients who lacked previous evidence of HCV infection; all had begun treatment at the clinic before July 2001. Hepatitis C virus genotype 3a was present in all 95 genotyped samples and presumably originated from a patient with chronic hepatitis C who began treatment in March 2000. Infection with HCV was statistically significantly associated with receipt of saline flushes (P < 0.001). Shared saline bags were probably contaminated when syringes used to draw blood from venous catheters were reused to withdraw saline solution. The clinic corrected this procedure in July 2001.Limitation: The delay between outbreak and investigation (> 1 year) may have contributed to an underestimate of cases.Conclusions: This large health care-associated HCV outbreak was related to shared saline bags contaminated through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/oncology clinics.