UNIVERSAL PRECAUTIONS PREVENT HEPATITIS-C VIRUS TRANSMISSION - A 54 MONTH FOLLOW-UP OF THE BELGIAN MULTICENTER STUDY

The isolation of anti-hepatitis C virus (HCV) in hemodialyzed (HD) pat ients has been repeatedly advocated to prevent nosocomial HCV transmis sion. We evaluated the incidence of seroconversion for HCV in Belgian HD patients, and demonstrate the complete prevention of HCV transmissi on by adherence to the universal precautions advocated by the Centers for Disease Control (Atlanta, GA, USA). All (N = 963) HD patients from 15 units, none of which isolates anti-HCV positive patients, were tes ted by a second or third generation enzyme-linked Immunosorbent assay (with confirmation by a second- or third-generation recombinant immuno blot assay or the polymerase chain reaction) every 18 months from May 1991 to November 1995. Follow-up was available in 488 patients (drop-o uts resulting from death or transplantation mainly). The yearly incide nce of seroconversion for HCV over the initial 18 months was 1.41%, wi th evidence suggestive of nosocomial HCV transmission. Universal preca utions were therefore reinforced. The incidence of seroconversion subs equently fell to 0.56% and 0%, respectively (P = 0.014), despite the f acts that the average transfusion load and the proportion of patients with dialyzer reuse or with monitors disinfected after each session di d not change significantly. We conclude that the strict enforcement of universal precautions fully prevents HCV transmission to HD patients. The isolation of anti-HCV positive patients is not warranted.