An Outbreak of Hepatitis C Virus Infections among Outpatients at a Hematology/Oncology Clinic

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Abstract
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. To determine the extent and mechanism of HCV transmission among clinic patients. Epidemiologic analysis through a cohort study. Hematology/oncology clinic in eastern Nebraska. Patients who visited the clinic from March 2000 through December 2001. HCV infection status, relevant medical history, and clinic-associated exposures. Bivariate analysis and logistic regression were used to identify risk factors for HCV infection. 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. The delay between outbreak and investigation (>1 year) may have contributed to an underestimate of cases. 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.