By Liz Highleyman

"Nosocomial" transmission in healthcare settings is the second most common route of hepatitis C virus (HCV) transmission, after shared use of needles and other drug injection equipment.

It is well known that HCV may be transmitted via accidental needle-sticks, but contact with the virus on contaminated surfaces in healthcare facilities may also play a role. Prior research indicates that HCV can remain viable on surfaces for up to 16 hours.

As reported in the September 1, 2008 issue of Clinical Infectious Diseases, French researchers conducted a prospective observational study to assess the roles of environmental contamination and non-compliance with standard precautions in cross-transmission of HCV between patients in a hemodialysis unit.

Patients undergoing long-term kidney dialysis at a French university hospital were systematically screened, revealing 2 cases of HCV transmission. An investigation was then launched to determine whether the patients were infected in the hemodialysis unit. Environmental contamination by blood and HCV RNA was assessed, as was compliance with accepted infection-control precautions such as hand-washing and use of gloves.

Results

• 2 patients experienced HCV seroconversion during the study period.

• Phylogenetic analyses showed that 1 of these patients was infected with the same strain as a chronically infected patient also treated in the unit.

• Of 740 environmental surface samples, 82 (11%) contained hemoglobin (a component of blood).

• 6 (7%) of the surface samples contained HCV RNA.

• The rate of compliance with hand hygiene was 37%.

• Gloves were immediately removed after patient care in 33% of cases.

• Poor hand hygiene and a low ratio of nurses to patients were independent predictors of the presence of hemoglobin on environmental surfaces.

"Blood-contaminated surfaces may be a source of HCV cross-transmission in a hemodialysis unit," the study authors concluded. "Strict compliance with hand hygiene and glove use and strict organization of care procedures are needed to reduce the risk of HCV cross-transmission among patients undergoing hemodialysis."

Infection Control Unit, French National Reference Center for Viral Hepatitis B, C, and delta, Department of Virology & INSERM U635 and Nephrology Ward, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France.

9/19/08

Reference
E Girou, S Chevaliez, D Challine, and others. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Clinical Infectious Diseases 47(5): 627-633. September 1, 2008. (Abstract).