Health Care-Associated Hepatitis C Virus Infections Attributed to Narcotic Diversion
Health Care-Associated Hepatitis C Virus Infections Attributed to Narcotic Diversion
复制标题
DOI：
10.7326/0003-4819-156-7-201204030-00002
复制
发表时间：
2012-04-03
影响因子：
39.2
通讯作者：
Perz, Joseph F.
中科院分区：
文献类型：
--
作者：
Hellinger, Walter C.;Bacalis, Laura P.;Perz, Joseph F.
背景资料：在一家卫生保健机构发现了三例与感染控制漏洞无关的遗传相关丙型肝炎病毒（HCV）感染病例。目的：调查HCV感染的卫生保健工作者通过药物转移向患者传播的情况。设计：聚类和回顾性调查。设置：急性护理医院和附属多专科诊所。患者：HCV传播期间的住院患者和门诊患者。测量：员工工作和麻醉品配药记录，HCV抗体和RNA的血液检测，以及NS 5 B基因和E2基因高变区1的测序。结果：21名员工被记录为正在工作或从自动配药柜中取出麻醉剂，该自动配药柜位于向3名病例患者中的每一名给予麻醉剂的区域;所有员工都提供了用于HCV检测的血液样本。一名员工感染的丙型肝炎病毒与3例患者的丙型肝炎病毒株NS 5 B序列同源性超过95%。准种分析表明，与每个病例患者的变异体有密切的遗传相关性，核苷酸同源性超过97.9%。员工承认注射了鸦片剂。一项调查确定了6132名患者因药物转移而有暴露于HCV的风险。在3929名存活患者中，3444名（87.7%）接受了感染筛查。两个额外的情况下，遗传相关的HCV感染归因于employees.Limitation：在HCV暴露的风险，12.3%的患者的生活中没有tested.Conclusion：5例HCV感染发生在3至4年内归因于药物转移由HCV感染的医护人员。需要研究药物转移和评估战略，以防止麻醉品篡改所有卫生保健环境。
Background: Three cases of genetically related hepatitis C virus (HCV) infection that were unattributable to infection control breaches were identified at a health care facility.Objective: To investigate HCV transmission from an HCV-infected health care worker to patients through drug diversion.Design: Cluster and look-back investigations.Setting: Acute care hospital and affiliated multispecialty clinic.Patients: Inpatients and outpatients during the period of HCV transmission.Measurements: Employee work and narcotic dispensing records, blood testing for HCV antibody and RNA, and sequencing of the NS5B gene and the hypervariable region 1 of the E2 gene.Results: 21 employees were recorded as being at work or as retrieving a narcotic from an automated dispensing cabinet in an area where a narcotic was administered to each of the 3 case patients; all employees provided blood samples for HCV testing. One employee was infected with HCV that had more than 95% NS5B sequence homology with the HCV strains of the 3 case patients. Quasi-species analysis showed close genetic relatedness with variants from each of the case patients and more than 97.9% nucleotide identity. The employee acknowledged parenteral opiate diversion. An investigation identified 6132 patients at risk for exposure to HCV because of the drug diversion. Of the 3929 living patients, 3444 (87.7%) were screened for infection. Two additional cases of genetically related HCV infection attributable to the employee were identified.Limitation: Of the living patients at risk for HCV exposure, 12.3% were not tested.Conclusion: Five cases of HCV infection occurring over 3 to 4 years were attributed to drug diversion by an HCV-infected health care worker. Studies of drug diversion and assessments of strategies to prevent narcotics tampering in all health care settings are needed.