1 Department of Nephrology and Dialysis 2 Department of Infectious Diseases 3 Department of Immunohematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
Sir,
Haemodialysis units have been recognized as a high-risk environment for the transmission of blood-borne infections. In our unit we had an outbreak of non-A, non-B hepatitis involving over 40 patients between 1980 and 1985 [1]. After that we started a preventive programme based on universal precautions to minimize the risk of exposure to hepatitis C virus (HCV), with good results [2]. Actually, from 1990 to March 1997 we had no cases of seroconversion to HCV antibodies among new patients starting haemodialysis treatment. Surprisingly, from March 1997 to January 1998 we had five new cases, as reported in Table 1. We were seriously considering the possibility of a new cluster of HCV infection which might have been favoured by our lowering attention for universal precautions of blood-borne infections.
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We then controlled the day and turn of dialysis of all five patients from June 1996 to January 1998. We found that only patients No. 4 and 5 were regularly dialysed in the same room and turn. Moreover, the genotyping of our five new cases revealed different HCV subtypes.
We conclude that this apparent cluster of HCV infection was not an epidemic but corresponded to independent infections, possibly related to surgical procedures (patients Nos 1,3 and 4) or community acquired infection (patient No. 2). Only one out of the five cases was potentially acquired in the dialysis unit. After January 1998 we followed the usual procedure to avoid exposure to HCV and until January 1999 no other cases have occurred. This observation led to a debate with dialysis staff as to the importance of respecting universal precaution measures in the unit. We think that it is useful to maintain permanent alertness on blood-borne infections.
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