Health Care-Associated Hepatitis C Infections Reviewed

As a new year begins, the spread of hepatitis C infection through the health care system continues to be a public health concern and is the subject of a review study that appeared in the December 14 issue of World Journal of Gastroenterology.

The blood-borne virus is considered a major public health threat because chronic infection can go years without detection and can result in severe damage to the liver. Recent advancements in newly developed drugs to treat the hepatitis C virus (HCV) have fueled hope of a cure for the more than 100 million people across the globe believed to be infected.

There is no vaccine for the virus, which has 11 recognized genotypes and several subtypes. It is this variability of the viral genome along with a poor understanding of the pathophysiology of chronic HCV infection that hinders progress on the vaccine development front, according to the article.

Medical settings such as hospitals, clinics, surgery departments, and transplantation wards have been implicated in the dissemination of HCV, the article states. Care that exposes HCV-infected blood to others poses a risk of infection that is shared among patients and health care workers alike.

To reach a goal of eradicating HCV in the coming decades, it is important to halt transmission of the virus particularly in the field of care-associated infection, according to the review article. It identifies and discusses the following three situations in which the virus can be acquired:

From infected patient to non-infected patient

From infected patient to a health care worker

From infected health care worker to non-infected patient

In previous decades before the virus was discovered in 1989, blood transfusions were a common vehicle of HCV transmission. Infected blood donors could not be identified to prevent them from donating because there was no test to screen for the virus.

“In the past, many people have been contaminated via blood products and unsafe injections because the risk was unknown, the virus was unidentified and the hygienic practices were not well established,” states the article. “Before the era of HIV/AIDS, blood was considered as a safe matrix and blood-borne pathogens were not identified as serious health care problems.”

Currently in developed countries the risk of HCV transmission via the administration of blood products has been dramatically reduced since regular testing of blood supplies began after discovery of the virus. However the conditions are “alarmingly” different in 39 developing countries where as recent as 2012 there was no routine screening for the virus in blood supplies.

Other concerns are unsafe injection practices such as reuse of syringes, vials or saline bags that help the virus spread from the infected to the uninfected in various clinics and other nonhospital health care settings. In 2007 after an HCV outbreak in a Nevada endoscopy clinic, eight other clusters of HCV infections were identified retrospectively in different American medical settings. Between 1998 and 2008 there were 275 patients found to be infected by one of the above mentioned means, according to the article.

The article authors support an increase in efforts to inform and educate health care workers on the risks inherent in blood-borne infections. It also stresses the importance of wide spread adoption of standard precautions among health care workers such as regular hand washing and wearing of protective gloves, masks and gowns, as well as work practices and safe injection practices with single-use disposable needles and syringes.

“Despite the absence of a prophylactic vaccine, most of the conditions are met for controlling the HCV risk in health care settings,” state the authors. “With the conviction that where there is will there is a way, this goal can and must be achieved in the next years.”