An outbreak of healthcare-associated transmission of HIV infections in a Jizan hemodialysis unit and an assessment of infection control practices in Jizan, Riyadh and Abha Regions, Saudi Arabia
Hemodialysis has been associated with increased risk of healthcare-associated infections (HAIs) butis regarded as a low-risk setting for HIV transmission. In January 2012 the Jizan Region Health Department reported that three hemodialysis patients had acquired healthcare-associated HIV infections. We investigated the outbreak to assess whether HIV transmission was hemodialysis-associated and to identify and correct factors contributing to transmission
Methodology
We interviewed and obtained blood samples from the three affected patients; reviewed 18 months of serology screening tests for evidence of new HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections; and performed phylogenetic analyses of HIV isolated from the three patients. Standardized protocols were used to interview hemodialysis unit (HDU) staff, and observe infection prevention and control (IPC) practices.
Results
HIV and HCV seroconversion rates were higher in HDU#1 (5.7%, 6.5%, respectively) than in all 11 other HDUs in Jizan and Riyadh Health Regions (0%, Fisher's Exact 2-tailed p=0.0008 and 0.15%; FET-2 p=0.006, respectively). Practices were observed in the implicated HDU#1 that were likely to promote transmission of HAIs. None of the three patients that acquired HIV had exposures outside the HDU. All three had infections with a sub-type C HIV-1 for which the pol, gag and env sequences fell into common clusters.
Conclusion
Molecular virological data strongly supported the epidemiological conclusion that patients were infected through hemodialysis-associated exposure resulting from inadequately disinfected equipment and/or contaminated shared multi-use vials. Adherence to standard IPC precautions, auditing and feedback of IPC practices, and timely use of surveillance data are essential to prevent HAIs in HDUs.