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Three cases of genetically related healthcare associated hepatitis C virus (HCV) infection appearing at a single healthcare facility could not be epidemiologically linked using hypotheses derived from breaches of infection control.
Objective:
To identify a source of healthcare associated HCV infection using a hypothesis of transmission through drug diversion.
Methods:
Medical records of case patients were reviewed to identify every episode of care (EOC) prior to HCV infection during which benzodiazepines or opiates were administered parenterally. In each area where an EOC was performed, employee work records and records of medication dispensing units (MDUs) were reviewed. Employees documented as being at work during at least one EOC for each case patient were asked to provide a blood sample for HCV testing. The same testing was requested of employees who retrieved benzodiazepines or opiates for parenteral administration from MDUs on the day of, or up to three days before, at least one EOC for each case patient. Specimens yielding HCV were submitted for NS5b sequencing and quasispecies analysis through sequencing of the hyper-variable region (HVR1) of the E1-E2 genes.
Results:
21 employees were identified for blood testing. All submitted specimens. One was found to have HCV infection with >95% NS5b sequence homology with the HCV strains of the three case patients. Quasispecies analysis revealed overlap with strains of each of the case patients and >99% nucleotide identity. Upon further questioning, this employee admitted diverting parenteral opiates during the period when all three case patients acquired HCV infection.
Conclusions: Three cases of healthcare associated HCV infection were attributed to drug diversion by a HCV infected healthcare worker. Surveillance and investigation of healthcare associated HCV infection is important to patient safety. Measures to reduce risk to patients from drug tampering through narcotic security are warranted.