Hepatitis C virus in the hemodialysis setting: detecting viral RNA from blood port caps by reverse transcription-polymerase chain reaction.
Academic Article
Overview
abstract
BACKGROUND: A widely observed increased risk of hepatitis C virus (HCV) infection in chronic hemodialysis patients has been previously attributed to violations of "Universal Precautions" for the control of blood-borne pathogens, as well as in part, to other risk factors, such as a history of blood transfusion or injection drug use. However, specific factors responsible for transmission have not been identified and the possibility that flaws in dialysis procedures, including sterilization, could increase the risk of transmission, has not been excluded. METHODS: We investigated reuse procedures for hemodialysis equipment and tested dialyzer blood port caps for detection of hepatitis C virus RNA (HCV RNA) by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Following artificial contamination of the blood port caps with blood or fluids from human HCV-positive patients, and overnight soaking in 1% Renalin, HCV RNA was detected on 4 of 20 caps contaminated with blood, 1 of 10 contaminated with serum and 8 of 24 contaminated with dialyzer blood compartment residue. HCV RNA was also detected on 1 of 111 pairs of blood port caps collected post dialysis from HCV positive patients, after soaking the caps overnight in 1% Renalin. CONCLUSION: The results suggest that HCV RNA might be detectable on reused dialysis equipment post sterilization procedures, if residual blood or serum is not entirely or almost entirely removed prior to sterilization. This may warrant evaluation of sterilization procedures to ensure that procedures are adequate and that protocols are rigorously followed. Further studies of sterilization procedures by sensitive techniques such as RT-PCR may be indicated.
