Health care-associated hepatitis C virus infection

Table 1 Distribution of main risk factors and hepatitis C virus genotypes in different countries worldwide (inspired from[13-15])

Country	Prevalence rate of HCV infection	Risk factors (≥10%)		Most frequent (≥10%) genotype(s) (%)
		Three top (or less)	Level of confidence1
Egypt	14.90%	Parenteral injections with multiuse syringe for schistosomiasis	High	4 (93)
		Blood transfusion
		Needle reuse
Italy	5.20%	Parenteral injections with multiuse syringe for popular therapies	Intermediate	1 (62)
		Blood transfusion		2 (27)
		IDU
Pakistan	4.70%	Syringe/needle reuse	High	3 (68)
		Surgery/dental work		1 (12)
		Blood transfusion
Taiwan	4.40%	Medical injection	High	1 (48)
		Blood transfusion		2 (40)
		Acupuncture
Romania	3.50%	Dental work	Intermediate	1 (99)
		Surgery
		Blood transfusion
Thailand	2.80%	IDU	Intermediate	3 (53)
		Tattooing		1 (33)
		Blood transfusion
Spain	2.64%	Surgery/dental work	Intermediate	1 (65)
		Syringe reuse		3 (20)
		IDU
Vietnam	2%-2.9%	Blood transfusion	Low	1 (47)
		IDU		6 (47)
		Tattooing
Russia	2%-2.5%	Blood transfusion	Intermediate	1 (56)
		IDU		3 (35)
		Acupuncture/tattooing
Israel	1.96%	Blood transfusion	Intermediate	1 (70)
		IDU		3 (20)
Poland	1.90%	Blood transfusion	Low	1 (58)
		Healthcare-related occupational exposure		3 (31)
		IDU
Czech Republic	1.5%-2%	IDU	Intermediate	1 (79)
		Blood transfusion		3 (20)
		Surgery
Switzerland	1.25%-1.75%	IDU	High	1 (51)
		Healthcare-related occupational exposure		3 (30)
		Blood transfusion
Portugal	1.50%	IDU	Low	1 (52)
		Surgery		3 (34)
		Sexual contacts
China	1%-1.9%	Syringe/needle reuse	Low	1 (68)
		Blood transfusion		2 (14)
		Esophageal balloon		6 (13)
Greece	1%-1.9%	IDU	Intermediate	1 (47)
		Blood transfusion		3 (27)
				4 (15)
India	1%-1.9%	Blood transfusion	Intermediate	3 (62)
		Syringe/needle reuse		1 (31)
		Healthcare-related occupational exposure
Japan	1%-1.9%	Blood transfusion	Intermediate	1 (63)
		Syringe/needle reuse		2 (25)
		IDU
Saudi Arabia	1%-1.9%	Blood transfusion	Low	4 (74)
		Parenteral injections with multiuse syringe for schistosomiasis		1 (14)
		Tattooing
Syria	1%-1.9%	Blood transfusion	Intermediate	4 (59)
		Hemodialysis		1 (29)
		Tattooing		5 (10)
Brazil	1.40%	IDU and nasal drugs	Not available	1 (65)
		Syringe/needle reuse		3 (30)
		Healthcare-related occupational exposure
Australia	1.30%	IDU	High	3 (31)
				1 (14)
South Korea	1.30%	Blood transfusion	Intermediate	1 (50)
		History of endoscopy		2 (45)
		Tattooing
Canada	1.01%	IDU	Intermediate	1 (60)
		Blood transfusion		3 (22)
				2 (15)
Scotland	1.00%	IDU	High	1 (47)
		Blood transfusion		3 (47)
		Tattooing
Turkey	1.00%	Blood transfusion	Low	1 (97)
		Surgery
		Dental work
France	0.84%	IDU and nasal drugs	Intermediate	1 (57)
				3 (21)
Norway	0.70%	IDU	High	1 (61)
				3 (28)
				2 (11)
England/Wales	0.60%	IDU	High	1 (45)
				3 (40)
Hungary	0.60%	Surgery	Low	1 (97)
		Blood transfusion
		Tattooing
Sweden	0.59%	IDU	High	1 (45)
				3 (34)
				2 (19)
Germany	0.40%	IDU	High	1 (62)
		Blood transfusion		3 (28)

¹The level of confidence of the different risks was appreciated by the size of the sampled population with regard to that of the whole population of the country. Risk factors related to health care are italicized. HCV: Hepatitis C virus; IDU: Intravenous drug users.

Table 2 Cases of transmission of hepatitis C virus from health care workers to patients reported in the literature between 1991 and 2005

Year of identification of the index case	Country	Occupation of HCW	Infected patients (n)	Infected (in case of look-back study)	Risk factor(s) identified	Ref.
1991	United States	Technician of an ambulatory surgical center	Approximately 40	NA	IDU	[74]
1992-1994	Spain	Cardiothoracic surgeon	5	2.25%	EPPs (cardiac valve replacement)	[75]
1994	United Kingdom	Cardiothoracic surgeon	1	0.36%	EPPs	[76]
1996	United States	Anesthesiologist	1	0.28%	Probable IDU	[77]
					Contaminated by another patient
1996	France	Not precised for confidentiality reasons	1	NA	EPPs (coronary artery replacement surgery)	[78]
1998	Germany	Anesthesiologist assistant	5	NA	Contaminated by another patient via an unprotected wound on hand	[79]
					Failure to use standard precautions (notably lack of gloving)
1998	Spain	Anesthesiologist	217 to 275 over a 10-yr period	NA	IDU	[80,81]
1999	United Kingdom	Gynecologist-obstetrician	8 over a 20-yr period	0.18%	EPPs	[82-84]
1999	United Kingdom	General surgeon	4	0.29%	NA	[84]
1999	United Kingdom	General surgeon	2	0.27%	NA	[85]
2000	Germany	Orthopedic surgeon	1	0.48%	EPPs	[86]
2000	Germany	Gynecologist-obstetrician	1 over a 7-yr period	0.04%	EPPs	[87]
					Failure to use standard precautions
2000	United States	Cardiothoracic surgeon	14 over a 10-yr period	1.49%	EPPs	[88]
2001	United Kingdom	Gynecologist-obstetrician	1	NA	EPPs	[89]
2001	Germany	Anesthesiologist	3	NA	Failure to use standard precautions (notably lack of gloving)	[90]
2003	Israel	Anesthesiologist	33	NA	IDU	[91]
2004	United States	Nurse anesthetist	15	NA	IDU	[92]
2005	United Kingdom	Gynecologist-obstetrician	1	NA	EPPs	[93]
2005	United Kingdom	Gynecologist-obstetrician	1	NA	EPPs	[93,94]
Not specified	United Kingdom	Anesthesiologist	1	NA	None	[95]

NA: Not available; IDU: Intravenous drug user; EPPs: Exposure-prone procedures; HCW: Health care worker.

Table 3 Main preventive measures aimed at blocking the transmission of hepatitis C virus in health care settings according to the situations schematized in Figure 1

	Prevention of patient to patient HCV transmission	Prevention of patient to HCW HCV transmission	Prevention of HCW to patient HCV transmission
Standard Precautions	X	X	X
Work practice controls	X	X	X
Engineered safety devices for injections		X	X
Use of single-use devices for injections	X
Biological screening of blood products, tissue and grafts	X
Restriction of activity of infected providers			X
Antiviral treatment of infected providers			X

HCV: Hepatitis C virus; HCW: Health care worker.