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World J Gastroenterol. Dec 14, 2014; 20(46): 17265-17278
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17265
Health care-associated hepatitis C virus infection
Bruno Pozzetto, Meriam Memmi, Olivier Garraud, Xavier Roblin, Philippe Berthelot
Bruno Pozzetto, Meriam Memmi, Olivier Garraud, Xavier Roblin, Philippe Berthelot, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP EA3064), Faculty of Medecine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne, France
Bruno Pozzetto, Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, 42055 Saint-Etienne, France
Olivier Garraud, Institut National de la Transfusion Sanguine, 75015 Paris, France
Xavier Roblin, Department of Gastroenterology and Hepatology, University-Hospital of Saint-Etienne, 42055 Saint-Etienne, France
Philippe Berthelot, Department of Infectious Diseases and Hygiene, University-Hospital of Saint-Etienne, 42055 Saint-Etienne, France
Author contributions: Pozzetto B planned the review article and wrote the manuscript; Memmi M updated the bibliography and contributed to the writing of the manuscript; Garraud O managed the part related to blood products; Roblin X corrected the manuscript from the hepatologic and endoscopic point of view; Berthelot P gave ideas and councils in hygiene; All the co-authors approved the final version of the manuscript.
Correspondence to: Bruno Pozzetto, Professor, Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, CHU de Saint-Etienne, Cedex 02, 42055 Saint-Etienne, France. bruno.pozzetto@univ-st-etienne.fr
Telephone: +33-4-77828434 Fax: +33-4-77828460
Received: July 31, 2014
Revised: October 25, 2014
Accepted: November 18, 2014
Published online: December 14, 2014
Abstract

Hepatitis C virus (HCV) is a blood-borne pathogen that has a worldwide distribution and infects millions of people. Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health. The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified: (1) infected patient to non-infected patient; (2) infected patient to non-infected health care worker (HCW); and (3) infected HCW to non infected patient. For each condition, the circumstances of contamination are described together with the means to prevent them. As a whole, the more important risk is represented by unsafe practices regarding injections, notably with the improper use of multidose vials used for multiple patients. The questions of occupational exposures and infected HCWs are also discussed. In terms of prevention and surveillance, the main arm for combating care-associated HCV infections is the implementation of standard precautions in all the fields of cares, with training programs and audits to verify their good application. HCWs must be sensitized to the risk of blood-borne pathogens, notably by the use of safety devices for injections and good hygiene practices in the operating theatre and in all the invasive procedures. The providers performing exposed-prone procedures must monitor their HCV serology regularly in order to detect early any primary infection and to treat it without delay. With the need to stay vigilant because HCV infection is often a hidden risk, it can be hoped that the number of people infected by HCV via health care will decrease very significantly in the next years.

Keywords: Hepatitis C virus, Health care-associated infection, Health care worker, Standard precautions, Hemodialysis, Unsafe injections, Occupational exposure, Antiviral drugs

Core tip: Hepatitis C virus (HCV) is a blood-borne pathogen that has a worldwide distribution and infects millions of people. Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health. The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified: (1) infected patient to non-infected patient; (2) infected patient to non-infected health care worker; and (3) infected HCW to non-infected patient.