On the 18th of February 2018, the Saudi Arabian Ministry of Health was notified of a cluster of new hepatitis C virus (HCV) infections among patients at a renal hemodialysis center, Facility A. Patients were asymptomatic, and they detect it while they are doing routine serology screening every six months. We sought to identify the risk factors for HCV infection at Facility A.
Methodology
We defined cases as a patient treated at Facility A, between October 1, 2017-October 30, 2018, who was HCV-antibody serology negative on center admission but subsequently seroconverted. To identify the source of the outbreak: we interviewed case-patients for risk factors (i.e., surgical history, blood transfusion and others) and conducted an environmental investigation. We assessed infection control practices and reviewed available records on staff management and maintenance of dialysis machines.
Results
Twelve case-patients were identified out of 133 susceptible patients treated at Facility A (attack rate = 9%). All case-patients were females who were dialyzed in the same room. Three case-patients had symptoms consistent with acute HCV infection. Two case-patients had increased serum Aspartate aminotransferase (AST) levels. Three case-patients died from unrelated causes. We observed gaps in hand hygiene, potentially unsafe parenteral infusion administration, and inadequate disinfection of machines between patients. Staff interviews revealed shortages in some equipment.
Conclusion
We identified a common exposure to the same treatment room among case-patients at Facility A. We identified gaps in hand hygiene, and inadequate disinfection procedures and errors in infusion administration that could have resulted in patients being exposed to contaminated equipment. These cross-contaminations were the most likely source of the outbreak. New policies were created to improve training and documentation of nursing practices. Dialysis machine disinfection policies were changed to decrease the risk of transmission of bloodborne disease. Dialysis machines are now used by a specific number of patients for better tracking of any new events.