Mayo Clinic, Jacksonville, Florida 32224, USA.
Ann Intern Med. 2012 Apr 3;156(7):477-82. doi: 10.7326/0003-4819-156-7-201204030-00002.
Three cases of genetically related hepatitis C virus (HCV) infection that were unattributable to infection control breaches were identified at a health care facility.
To investigate HCV transmission from an HCV-infected health care worker to patients through drug diversion.
Cluster and look-back investigations.
Acute care hospital and affiliated multispecialty clinic.
Inpatients and outpatients during the period of HCV transmission.
Employee work and narcotic dispensing records, blood testing for HCV antibody and RNA, and sequencing of the NS5B gene and the hypervariable region 1 of the E2 gene.
21 employees were recorded as being at work or as retrieving a narcotic from an automated dispensing cabinet in an area where a narcotic was administered to each of the 3 case patients; all employees provided blood samples for HCV testing. One employee was infected with HCV that had more than 95% NS5B sequence homology with the HCV strains of the 3 case patients. Quasi-species analysis showed close genetic relatedness with variants from each of the case patients and more than 97.9% nucleotide identity. The employee acknowledged parenteral opiate diversion. An investigation identified 6132 patients at risk for exposure to HCV because of the drug diversion. Of the 3929 living patients, 3444 (87.7%) were screened for infection. Two additional cases of genetically related HCV infection attributable to the employee were identified.
Of the living patients at risk for HCV exposure, 12.3% were not tested.
Five cases of HCV infection occurring over 3 to 4 years were attributed to drug diversion by an HCV-infected health care worker. Studies of drug diversion and assessments of strategies to prevent narcotics tampering in all health care settings are needed.
None.
在一家医疗机构发现了 3 例无法归因于感染控制失误的基因相关丙型肝炎病毒 (HCV) 感染病例。
调查 HCV 感染的医护人员通过药物转移将 HCV 传染给患者的情况。
集群和回溯调查。
急症护理医院和附属多专科诊所。
HCV 传播期间的住院患者和门诊患者。
员工工作和麻醉药品发放记录、HCV 抗体和 RNA 检测以及 NS5B 基因和 E2 基因高变区 1 的测序。
有 21 名员工记录在案，他们在给 3 例病例患者中的每一位患者给药的区域内工作或从自动发药柜中取麻醉药；所有员工均提供 HCV 检测血样。一名员工感染的 HCV 与 3 例病例患者的 HCV 株有超过 95%的 NS5B 序列同源性。准种分析显示与每个病例患者的变异体密切遗传相关，核苷酸同一性超过 97.9%。该员工承认静脉内阿片类药物转移。一项调查确定了因药物转移而有感染 HCV 风险的 6132 名患者。在 3929 名存活患者中，有 3444 名（87.7%）接受了感染筛查。另外发现了 2 例归因于该员工的基因相关 HCV 感染病例。
有感染 HCV 风险的存活患者中，有 12.3%未接受检测。
5 例 HCV 感染病例归因于 HCV 感染的医护人员药物转移，需要对药物转移进行研究，并评估所有医疗保健环境中防止麻醉品篡改的策略。
无。
