Hepatitis c virus infection in employees of a large university hospital in Israel.

OBJECTIVE: To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel. DESIGN: Seroprevalence survey. SETTING: A 1,006-bed, tertiary-care university hospital in Jerusalem. PARTICIPANTS: All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey. METHODS: Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables. RESULTS: Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood > or = 10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia. CONCLUSIONS: Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.     

Risk Factors for Hepatitis C Virus Infection among Blood Donors in Georgia

BACKGROUND: Growing awareness about the importance of blood safety for controlling the transmission of hepatitis C virus (HCV) has helped to decrease the spread of this virus in many settings. This study was conducted in order to evaluate potential risk factors for HCV infection among blood donors in Georgia. METHODS: The study population consisted of 553 blood donors in three major Georgian cities: Tbilisi, the capital city and Batumi and Poti, naval port cities. Risk factors were examined using a behavior questionnaire. All blood samples were initially tested using 3rd generation anti-HCV enzyme-linked immunosorbent assays and confirmed using recombinant immunoblot assays and nucleic acid testing. RESULTS: Forty-three blood donors, 7.8%, were confirmed HCV positive. Significant risk factors included: drug injection ever (OR: 42; 95% CI: 3.2-550.7); history of hepatitis (OR: 25.9; 95% CI: 4.6-145.5); history of a previous surgical procedure (OR: 148.4; 95% CI: 26.9-817.4); blood transfusion (OR: 25.9; 95% CI: 3.2-210.9). CONCLUSIONS: This study found a very high prevalence of HCV among blood donors in Georgia. The main risk factor for HCV infection in this population of blood donors was previous contact with contaminated blood or blood products. Reliable screening of donors and their blood is critical for controlling the further spread of HCV in Georgia.     

Risk factors associated with hepatitis C virus infection in Taiwanese government employees

This study evaluated the roles of multiple factors in hepatitis C virus (HCV) infection, with emphasis on the modification of various individual characteristics on the risk associated with percutaneous exposure to blood. Serum samples taken from 4869 men in Taiwan within a cohort study were tested for HCV antibody. The overall positive rate of anti-HCV was 1.6%. In a logistic regression, factors positively associated with anti-HCV positivity were previous blood transfusion (odds ratio [OR] = 7.28: 95% confidence interval [CI] = 4.26-12.45), a history of surgery (OR = 2.06: 95% CI = 1 23-3.46), and lower educational levels (OR = 1.94; 95% CI = 1.14-3.32). The anti-HCV positive rate was significantly lower in hepatitis B surface antigen (HBsAg) carriers than in non-carriers (OR = 0.60; 95% CI = 0.37-0.95). Ageing, lower educational levels, O blood group, and Taiwanese ethnicity enhanced the likelihood of HCV infection through blood transfusion/surgery, whereasHBsAg status, cigarette smoking, and habitual alcohol drinking reduced it.     

Risk factors for hepatitis C virus infection. A case-control study of blood donors in the Trent Region (UK).

The introduction of screening for hepatitis C virus (HCV) by the National Blood Transfusion Service identified donors who had acquired HCV infection. We undertook a case-control study amongst blood donors in the Trent Region to determine risks for HCV infection. A total of 74 blood donors confirmed positive for hepatitis C infection and 150 age, sex and donor venue matched controls were included in the study. Fifty-three percent of hepatitis C infected blood donors reported previous use of injected drugs compared to no controls; relative risk (RR) not estimatable (lower limit 95% CI = 20). Other risk factors were a history of: receipt of a blood transfusion or blood products RR = 3.6 (95% CI 1.5-8.3), having been a ''health care worker'' RR = 2.8 (95% CI 1.1-7.6), tattooing RR = 3.3 (95% CI 1.2-8.7), and an association with having been born abroad RR = 3.2 (95% CI 1.1-9.5). No risk was shown for a history of multiple sexual partners, ear piercing or acupuncture. Injecting drug use explains more than 50% of hepatitis C infections in blood donors, a group who are less likely to have injected drugs than the general population.     

Medical procedures and the risk of iatrogenic hepatitis C infection: case-controlled study in north-eastern Poland

Many hepatitis C virus (HCV)-infected individuals do not have any obvious risk factors and one of the putative sources of infection may be inadvertent exposure to infected blood or body fluids in the clinical setting. The aim of this study was to assess the role of medical procedures in transmission of hepatitis C in north-eastern Poland. In total, 194 patients with chronic hepatitis C were eligible for the study. The control group consisted of 275 age- and sex-matched individuals. Patients with a history of intravenous drug use were excluded. On multivariate analysis, transfusions [odds ratio (OR) = 3.7, 95% confidence interval (CI) 2.2-6.3], minor surgery (OR = 3.2, 95% CI 1.5-6.7) and dental care (OR = 2.3, 95% CI = 1.4-4.0) were independently associated with HCV infection. We conclude that apart from transfusion, minor medical procedures and dental care may carry a significant risk of hepatitis C infection. Improvements in basic hygiene routines and strict adherence to universal precautions may be essential to prevent iatrogenic transmission of the infection.     

Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment

A prospective survey was conducted over six months in order to estimate the proportion of reported occupational needlestick injuries sustained by National Health Service (NHS) Scotland staff that could have been prevented through either safety device introduction, improved guideline adherence, guideline revision or a combination of these. This survey involved the administration of a standard proforma to healthcare workers followed by an expert panel assessment. All acute and primary care NHS Scotland trusts, the Scottish Ambulance Service and the Scottish National Blood Transfusion Service were included. Proforma and expert panel assessment data were available for 64% of injuries (952/1497) reported by healthcare staff. These injuries were all percutaneous. The expert panel concluded that: 56% of all injuries and 80% of venepuncture/injection administration injuries would probably/definitely have been prevented through safety device usage, 52% of all injuries and 56% of venepuncture/injection administration injuries would probably/definitely have been prevented through guideline adherence and 72% of all injuries and 88% of venepuncture/injection administration injuries would probably/definitely have been prevented through either intervention. Multi-factorial analysis indicated that injuries sustained through venepuncture/injection administration were significantly more likely to be prevented through safety device usage [adjusted odds ratio (OR) 5.09, 95% confidence intervals (CI) 3.11-8.31 and adjusted OR 2.70, 95% CI 1.64-4.45, respectively], and significantly less likely to be prevented through guideline adherence (adjusted OR 0.26, 95% CI 0.11-0.60 and adjusted OR 0.31, 95% CI 0.12-0.78, respectively). Injuries sustained after completing procedures were significantly more likely to be prevented through safety device usage and guideline adherence. The study's findings support the need for improvements to staff's adherence to needlestick injury guidelines and appropriate implementation of safety devices for venepuncture and injection administration.     

Prevalence and factors associated with HCV (hepatitis C virus) seropositivity in Islamabad, Pakistan

An estimated 150-200 million people worldwide are infected with hepatitis C. Prevalence is higher in some countries in Asia and Africa. Only limited information about the epidemiology of Hepatitis C Virus (HCV) infection especially in females is available. The aim of this study is to determine the prevalence of anti-HCV antibodies and the possible factors for transmission in the female population of a largely urban city Islamabad. A cross sectional study was conducted from May 2006 to August 2006 in Islamabad. We select 252 female households (n=252) following the selection criteria. The primary outcome variables were HCV seropositivity and factors like history of major surgical procedure, blood transfusion, Intravenous drug use etc. The results showed mean age of the sample was 33.21 (±9.95) years and HCV seropositivity was present in 62 (24.6%) females. Final Forward Stepwise multiple logistic regression showed blood transfusion [OR, 10.094 95% CI 1.950-52.257], dental procedure [OR, 5.381 95% CI 2.315-12.507] and dilation and curettage [OR, 3.869 95% 1.867-8.015] were significantly associated with HCV seropositivity in females. The study highlights poor quality of care provided and a massive need to educate general population including patients as well as health professionals and allied health workers.     

A nested case-control study of brain tumors among employees at a petroleum exploration and extraction research facility

Work-related exposures potentially associated with a cluster of brain tumors at a petroleum exploration and extraction research facility were evaluated in a nested case-control study. Fifteen cases were identified in the original cohort and 150 matched controls were selected. Odds ratios (ORs) for occupational exposure to petroleum, radiation, solvents, magnetic fields, and work activities were near or below 1.0. ORs near 1.5 were observed for: working with computers (OR = 1.47; 95% confidence interval [CI] = 0.30-9.35); work-related travel (OR = 1.48; 95% CI = 0.25-5.95), and travel immunizations (OR = 1.62; 95% CI = 0.23-9.45). Higher ORs were observed for work in administrative and marketing buildings and for achieving a master's or higher degree (OR = 2.0, 95% CI = 0.4-10.7). While some ORs above 1.5 were noted, no work-related chemical and physical exposures were significantly associated with the occurrence of brain tumors among employees at this facility.     

山西省某既往有偿献血地区18～59岁村民丙型肝炎病毒感染的横断面研究

目的估计山西省某农村既往有偿献血地区18～59岁村民丙型肝炎病毒（HCV）感染的流行率并分析HCV感染的可能危险因素。方法选择山西省某县12个村庄随机抽取660名18～59岁村民开展以社区为基础的横断面研究。采用标准化问卷收集研究对象的人口学、医疗史、危险行为等信息，采集7ml静脉血用于检测HCV感染。结果该既往有偿献血地区18～59岁村民总的HCV感染率为8．2％，献血人群HCV感染率为27．7％。多因素logistic回归分析提示，曾经献过血（调整OR=14．28，95％CI：6．83～29．87）和输过血（调整OR=8．66，95％CI：2．31～32．47）是该地村民感染HCV的主要危险因素。对献血亚人群分析发现，曾经献过血浆（调整OR=8．56，95％CI：2．87～25．54）是献血者感染HCV的最主要危险因素；1994年及以后停止献血的村民感染HCV的危险性较1994年之前停止献血的低（调整OR=0．32，95％CI：0．11～0．93）；女性献血者感染HCV的危险性较男性为低（调整OR=0．28，95％CI：0．10～0．83）。结论该献血地区HCV流行水平较高，既往有偿献血（浆）是该地区HCV流行的最主要原因。应采取有效措施预防该地区居民HCV的二代传播及为阳性患者提供治疗刻不容缓。     

Prevalence and associated factors to hepatitis C in hemodialysis patients in Brazil

OBJECTIVE: The prevalence of hepatitis C virus (HCV) is higher in patients on hemodialysis than in the general population, probably due to greater exposure to risk situations. The purposes of the study were to determine anti-HCV antibodies prevalence among hemodialysis patients and dialysis clinics and patients factors associated with HCV transmission. METHODS: A cross-sectional study was conducted in 752 hemodialysis patients in all 12 dialysis clinics of Fortaleza, Brazil, and were screened using third generation ELISA. Sociodemographic, clinical, and epidemiological data of 663 patients were collected through interviews. Nosocomial factors were assessed using a specific questionnaire tool. Statistical analysis was conducted using Student's t test, odds ratio and multivariate analysis. RESULTS: The prevalence of anti-HCV was 52% (390/746; ranged from 6% to 72%). The anti-HCV positivity was higher in patients who had previous peritoneal dialysis (OR=1.76; 95% CI 1.12-2.76) and blood transfusion (OR=2.75; 95% CI 1.25-6.03). Dialysis age has been associated with anti-HCV positivity (OR=1.47; 95% CI 1.35-1.61). Clinics practices associated with anti-HCV positivity were: previous preparing of heparin (OR=2.92; 95% CI 1.23-6.92), failure in gloves use or change (OR=5.73; 95% CI 1.75-18.72), unsatisfactory dialysis machine disinfection (OR=2.79; 95% CI 1.57-4.96), and patient isolation in dialysis room (OR=0.18; 95% CI 0.05-0.61). CONCLUSIONS: The results show high anti-HCV prevalence among hemodialysis patients and the association of nosocomial factors with new HCV infection cases.     

丙型肝炎病毒感染主要危险因素的Meta分析

目的 分析丙型肝炎病毒(HCV)感染的危险因素。方法计算机检索中国医院知识仓库(CHKD)、万方数据知识平台、EBSCO、西文生物医学期刊文献服务系统、Elsevier,并结合文献追溯的方法,收集1994-2010年公开发表的关于HCV感染危险因素的文献,研究类型为病例对照研究或队列研究,采用RevMan 5.0及St...     

Analysis of the mechanisms of minor occupational injuries in the construction industry in Spain

OBJECTIVES: The construction industry produces the highest number of occupational injuries in Spain (25.6%). Of these, 98.5% were minor injuries with 5 million workdays lost in 2000. This occurred even after the recent introduction of numerous health and occupational safety regulations. The objective of the present study was to identify the specific mechanisms of minor occupational injuries in the construction sector. METHODS: In 2000, there were 235,853 minor occupational injuries in the construction industry. From these, injuries in general construction and civil engineering were selected (n = 155,044). These injuries affected both the total number of workers in the sector as well as bricklayers and unskilled construction workers. Insurance and financial activities (n = 2,019) were selected as a reference economic sector. Minor occupational injuries due to nontraumatic processes (heart attack, etc.) were taken as a control group (n = 167), assuming that the risk of nontraumatic processes was independent of economic activities. Odds ratios (OR) were adjusted by age, sex, years of work experience, type of employment and company size through nonconditional logistic regression models. RESULTS: The mechanisms with the highest risk of minor occupational lesions in construction workers as a group compared with employees in the financial sector were projection of fragments (OR = 33.0; 95% CI, 15.3-70.8) and being struck by objects (OR = 18.2; CI 95%, 9.7-34.1). These were also the most specific mechanisms of injury in the subgroup of bricklayers and unskilled construction workers. CONCLUSIONS: Activities aimed at preventing minor occupational injuries in the construction sector should be orientated towards these mechanisms, especially projection of fragments despite the low frequency of this mechanism compared with that of other mechanisms. Case-control design is a useful alternative approach for research into occupational injuries.     

Safe inoculation of blood and bone marrow for liquid culture detection of mycobacteria

BACKGROUND: Needlestick injuries confer an unnecessary risk of occupational bloodborne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. After an accidental needlestick injury, procedures for inoculation of liquid culture media for rapid detection of Mycobacterium tuberculosis complex and other mycobacteria from blood and bone marrow specimens were reviewed. AIM: To identify a safer transfer device, which could replace the ordinary syringe in inoculation of liquid culture vials. METHODS: We identified a transfer device to transfer blood or bone marrow specimens from bedside tubes into liquid culture vials. CONCLUSION: The changed procedure will reduce the risk of needlestick accidents and be of benefit to other microbiological laboratories using the same or similar inoculation techniques.     

兰州市血液透析患者乙型肝炎病毒感染的危险因素

  目的  探讨兰州市血液透析患者乙型肝炎病毒(Hepatitis B virus，HBV)感染的危险因素。  方法  对兰州市五家医院血透门诊血透患者问卷调查，收集患者一般人口学资料、既往病史、血液透析过程相关因素、HBV病毒感染检测资料，对数据进行单因素及广义估计方程模型分析。  结果  共调查565例血液透析患者，其中HBV阳性31例，感染率为5.49%。广义估计方程模型分析显示使用血液制品(1 998年以前OR=8.077，95%CI:3.469~18.803；1998年以后OR=2.678，95%CI:1.719~4.170)、输血(1 998年以前OR=5.344，95%CI:2.212~12.910)、透析龄/月(OR=1.008，95%CI:1.002~1.014)、创伤性美容(OR=1.954，95%CI:1.015~3.766)、文化程度低(OR=3.564，95%CI:1.881~6.753)使透析患者感染HBV的风险提高；年龄>40岁(OR=0.214，95%CI:0.064~0.712)的血液透析患者相对于25岁以下患者乙型肝炎病毒表面抗原(hepatitis B surface antigen，HBsAg)阳性率较低。  结论  使用血液制品、输血、透析龄越长、创伤性美容和文化程度低能增加血透患者感染HBV风险，在临床中应格外重视血液和血液制品管理和使用，规范透析操作，加强乙型肝炎防治宣传工作。     

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.     

Risk factors for acute non-A, non-B hepatitis and their relationship to antibodies for hepatitis C virus: a case-control study.

A case-control study was carried out comparing 333 case subjects with non-A, non-B hepatitis and 1095 hospital control subjects. Of 333 case subjects, 197 (59%) were positive for hepatitis C antibody (anti-HCV). Excluding blood transfusion and intravenous drug use, surgical intervention and dental therapy were strongly associated with anti-HCV-positive cases: in particular, obstetric and gynecology surgical intervention was found to be strongly associated with HCV positivity (odds ratio [OR] = 32; 95% confidence interval [CI] = 7, 147). Raw shellfish consumption was a risk factor for anti-HCV-negative cases (OR = 2.2; 95% CI = 1.0, 5.1), thus suggesting an enterically transmitted virus in sporadic non-A, non-B hepatitis in Italy.     

Tattooing and transfusion-transmitted diseases in Brazil: a hospital-based cross-sectional matched study

Background: Presence of tattoos has been a criterion for temporary deferral of blood donors. Scientific evidence remains equivocal regarding the association between tattooing and transfusion-transmitted diseases (TTDs). Methods: A cross-sectional matched study was undertaken among adults attending a Brazilian hospital and blood bank. The exposure of interest was having at least one permanent tattoo, and the outcomes were the presence of serological markers for the following TTDs: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, syphilis, and Chagas' disease. Exposed and unexposed subjects were matched on age, sex, and main clinical complaint. Associations were assessed by odds ratios (ORs), adjusted for confounders by unconditional logistic regression. Findings: The study recruited 345 subjects, 182 with tattoos. Having a tattoo was associated with HCV (OR: 6.41; 95% confidence interval (CI) 1.29, 31.84), and with having at least one positive test for any TTD (OR: 2.05, 95% CI: 1.11, 3.81). No statistically significant associations were found between tattooing and HBV or HIV infection, syphilis or Chagas' disease, but these results are inconclusive given the large CI obtained. Interpretation: Having a tattoo is not an important indicator for testing positive for a TTD, except for HCV infection. Taking into consideration the increasing prevalence of tattooing in the general population, the absolute need of a safe and sustainable blood supply and optimization of the cost-effectiveness of screening blood donors, further research on tattoos is urgently required.     

An assessment of hepatitis C virus infection among health-care workers of the National Cancer Institute of Naples, Southern Italy

BACKGROUND: As many people with chronic hepatitis C virus (HCV) infection are asymptomatic, HCV infection could spread easily among the health-care workers of the National Cancer Institute of Naples (especially before the identification of HCV and in the absence of good, effective preventative measures, e.g. sterile syringe use, gloves, protective glasses). METHODS: In order to determine whether there is a transmission risk for HCV infection from patient to health-care worker, we carried out a cross-sectional study of a cohort of National Cancer Institute health-care workers in Naples, Southern Italy. RESULTS: The chi2-test was not significant; we did not find any significant risk for HCV in the 'other untrained staff' group [odds ratio (OR) 2.2; 95% confidence interval (CI) 0.4-10.9] or in the health-care workers group (OR 1.6; 95% CI 0.4-7.0). In the health-care worker subgroups, doctors were the reference category because of the low prevalence of HCV in this subgroup (3.3%). A non-significant association was found in the professional nurses group (OR 2.7; 95% CI 0.8-8.8), as well as in the categories of technicians and biologists. CONCLUSIONS: No excessive risk was found among the health-care workers as a whole or among the different categories of personnel, confirming that health-care employees have benefited sufficiently from preventative measures.     

基层医务人员锐器刺伤与血源性疾病感染风险定量评估

目的定量评估医务人员血源性疾病感染风险。方法调查乡镇卫生院基层医务人员锐器刺伤情况以及乙肝疫苗免疫率,采用Kane模型计算个人年感染概率。结果429名医务人员平均年锐器刺伤率50．82％,每人年刺伤频数为1．05,乙肝疫苗免疫率72．03％。HBV、HCV、HIV每万人年风险感染例数分别为239、99和0．08。结论通过锐器刺伤以及乙肝疫苗免疫率调查可以定量评估医务人员HBV等血源性疾病感染风险。