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BACKGROUND: Hepatitis C virus (HCV) is a blood-borne pathogen that is directly reportable to the New Jersey Department of Health (NJDOH). Of all healthcare procedures, more outbreaks of HCV have been associated with hemodialysis than any other procedures in New Jersey (NJ). Hemodialysis patients experience a high frequency of blood exposures through use of catheters or insertion of needles to access the blood. In June 2014, two patients who seroconverted to HCV positive status were reported to NJDOH by an outpatient dialysis facility. Both patients received treatment at the facility on the same days and times, and were identified via routine 6-month HCV antibody testing.
METHODS: The local health department conducted a medical record review for both patients to identify additional healthcare exposures. NJDOH requested patient schedules from the dialysis facility as well as station numbers, staff information, and a list of all chronic HCV patients on census during the six months prior to the two seroconversions. A site visit alongside surveyors from the NJDOH Division of Health Facilities Evaluation and Licensing (HFEL) was scheduled to observe infection control practices. Lastly, blood samples were collected from both seroconversions as well as any HCV chronic patients on census.
RESULTS: Chart reviews conducted by the local health department revealed the patients had no other shared healthcare exposures. A review of patient treatment schedules showed on numerous occasions the two seroconversions shared staff with other known chronic HCV patients (5 in total). The site visit with HFEL revealed infection control deficiencies including poor hand hygiene, inadequate environmental cleaning, poor record keeping, and a general lack of infection control oversight. Genotype testing and sequencing conducted at the Centers for Disease Control and Prevention (CDC) revealed the two seroconversions, and one known chronic HCV patients, to be genotype 1b, and a 99.66% match. The facility tested all HCV negative patients on census every month for six months, and in September 2014 an additional two seroconversions were identified, both of which matched the existing cluster by 96.73%.
CONCLUSIONS: Routine HCV antibody screening and genotyping revealed a HCV outbreak in a dialysis facility in NJ. Poor infection control practices and a lack of infection control expertise and oversight were likely responsible for this cluster. Due to the high prevalence of blood exposures, chronic dialysis facilities need to maintain routine HCV testing of patients and have good infection control practices to prevent blood-borne pathogen outbreaks.