To the Editor: Dr Sulkowski and colleagues1 present a case of occupational hepatitis C virus (HCV) infection in a medical intern following a needlestick from an intravenous (IV) catheter stylet. In reviewing the occupational risk of HCV infection, they state that "HCV transmission following a single needlestick accident occurs approximately 10 times more often than HIV [human immunodeficiency virus] transmission." This estimate appears to derive from studies reported in their Table, which reported a total of 333 HCV-exposed health care workers (HCWs), 14 of whom became infected, for an overall transmission rate of 4.2%. Integrating these studies published from 1992 through 1994 with several more recent reports shows that more than 11 000 HCV-exposed HCWs have been collectively followed up in 6 countries, with increasingly consistent results (Table 1). The simple average transmission rate for all reports is 0.5%, a rate similar to that for occupational HIV transmission, and much lower than the rate that Sulkowski et al report. View LargeDownload Table. Infection Rates Among HCV−Exposed Health Care Workers* Regarding the recommended follow-up schedule, we agree that HCV RNA testing should be performed only when early detection of HCV infection would alter clinical care. Given a 0.5% average infection rate, if performed routinely, 99.5% of such tests would have negative results. Thus, selective testing of cases with a higher than average transmission risk may be an alternative strategy. Transmission risk appears to increase if the source patient is coinfected with HIV, an observation supported both by surveillance studies2,3 and anecdotal reports (including the case reported by Sulkowski et al). Also, most cases of transmission resulted from needlesticks involving hollow-bore, blood-filled needles, which represent a small proportion of all needlesticks. HCV RNA tests targeting these circumstances may be justified. Most high-risk needlesticks from conventional IV catheter stylets are preventable through the use of safety-engineered IV catheters, which have been shown to be from 83% to 95% effective in preventing needlesticks.4-6 But the use of such protective devices to reduce risk of bloodborne infection is not merely a good idea—in the United States it is the law. The Needlestick Safety and Prevention Act,7 requiring these devices, went into full effect in July 2001. Consequently, not only is the risk of infection with HCV after an occupational exposure only a small fraction of what it was initially believed to be, but the risk of being exposed to HCV by a conventional IV catheter stylet can be reduced by more than 90% by complying with US regulations requiring the use of protective IV catheters and other needle devices. References 1. Sulkowski MSRay SCThomas DL Needlestick transmission of hepatitis C. JAMA. 2002;287:2406-2413.Google Scholar 2. Serra CTorres MCampins M Riesgo laboral de infeccion por el virus de la hepatitis C despues de una exposicion accidental [in Spanish]. Medicina Clinica. 1998;111:645-649.Google Scholar 3. Campbell SRSrivastava PWilliams IAlter MCardo Dand the NaSH Surveillance Group, Hepatitis C virus infection after occupational exposure. Infect Control Hosp Epidemiol. 2000;21:107.Google Scholar 4. Jagger JBentley MBfor the Collaborative EPINet Surveillance Group, Injuries from vascular access devices: high risk and preventable. J Intraven Nurs. 1997;20(suppl 6):S33-S39.Google Scholar 5. Mendelson MHChen LBYFinkelstein LEBailey EKogan G Evaluation of a safety IV catheter (Insyte Autogard, Becton Dickinson) using the Centers for Disease Control and Prevention (CDC) National Surveillance System for Hospital Healthcare Workers database. Abstract presented at: 4th Decennial International Conference on Nosocomial and Healthcare Associated Infections; March 5-9, 2000; Atlanta, Ga. 6. Mendelson MHLin-Chen BYFinkelstein-Blond LBailey EKogan G Evaluation of a safety IV catheter (IVC) (Becton Dickinson, INSYTE AUTOGARD). Abstract presented at: 11th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; May 2001; Toronto, Ontario. 7. Not Available, Needlestick Safety and Prevention Act of 2000. Pub L No.106-430, 114 Stat 1901 (2000).
JAMA – American Medical Association
Published: Sep 25, 2002