HCV outbreaks: What is risk to health workers?
HCV outbreaks: What is risk to health workers?
IC failures may reflect an overall lack of safety
Recent outbreaks of hepatitis C are a wake-up call to boost infection control practices, particularly in outpatient settings. But they also underscore the prevalence of HCV and the continued occupational risk to health care workers.
A review of investigations by the Centers for Disease Control and Prevention revealed that health care facilities have contacted more than 60,000 patients and asked them to be tested for hepatitis B due to the failure of health care workers to follow proper infection control practices. There were 33 outbreaks in outpatient clinics, hemodialysis centers, and long-term care facilities, resulting in transmission of HCV or hepatitis C to 450 people.1
The outbreak scenarios included cases in which health care workers reused syringes on multiple patients or contaminated multidose vials by reusing a syringe. Infection control lapses raise concern about an overall lack of safety. "If you've got a facility that's not practicing according to basic standards of safety and infection control, in terms of patient-to-patient transmission, then the chances are probably pretty good that they're not attending to worker safety either," says Jane Perry, MA, associate director of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.
There have been no recent prevalence studies of health care workers and hepatitis C, although past studies did not show an elevated rate. But a recent CDC analysis of death certificates indicates that health care workers have an occupational risk. Twenty years of data (1984 to 2004) from the National Occupational Mortality Surveillance System found that female health care workers have a 20% greater risk of dying from hepatitis C than women in other occupations. Male health care workers have a 50% elevated risk.2
"Our data doesn't link any of these deaths to specific occupational incidents," says Sara Luckhaupt, MD, medical officer in the surveillance branch of the Division of Surveillance, Hazard Evaluation and Field Studies at the National Institute for Occupational Safety and Health in Cincinnati.
But the consistency of the HCV finding was telling. "Since we found the association for both males and females [with HCV], it made us more suspicious that there was an occupational risk," she says.
An estimated 4 million Americans have a chronic hepatitis C infection, but because many of them aren't aware of the infection, HCV has been called "the hidden epidemic." The National Health and Nutrition Examination Survey (NHANES), which had about 15,000 participants from 1999 to 2002, found a peak prevalence in the 40 to 49 age group. Almost two-thirds (63%) of those who tested positive for HCV RNA said they had never been told they had "any kind of liver condition."3
References
- Thompson N, Perz JF, Moorman AC, et al. Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med 2009; 150:33-39.
- Luckhaupt S, Calvert G. Deaths due to bloodborne infections and their sequelae among health care workers. Am J Ind Med 2008; 51:812-814.
- Armstrong GL, Wasley A, Simard EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144:705-714.
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