Still a killer: Hepatitis C in Anesthesia
Pall Medical, part of Cytiva
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The World Health Organisation estimates that Globally 58 million people have a chronic hepatitis C virus (HCV) infection. Antiviral drugs, but no vaccination against an HCV infection is available.[i] In the USA HCV is the most common chronic blood-borne pathogen and it is associated with more deaths than the top 60 other reportable infectious diseases combined, including HIV.[ii] The estimated US-prevalence of chronic HCV infection is approximately 1.0%[iii] . In other words: 1 in 100 patients may host the virus and pose a threat for health care workers and other patients, in a busy operating room (OR) more than 1 HCV-positive patient may be on the list every month.
The virus load in the blood of an infected person may reach up to 8 million viruses/ mL.[iv] The number of virus particles needed to cause an infection depends on several factors but is generally considered to be as low as 10 – 100 viruses[v] , i.e., less than a drop (approximately 100 μL) of blood can cause HCV infection. It is therefore of paramount importance to adhere to effective cleaning and disinfection procedures and to implement preventative health and safety measures.
In the hospital’s OR patients on a surgical list share certain pieces of equipment, which need to be subjected to the appropriate measures for infection control. In most cases the patients’ anaesthetic procedure will require that they are connected to the quite complex anaesthesia workstation (AWS). ?As the AWS is in directly connected to the patients’ airway it may get contaminated with blood or respiratory secreta. Cases of patient to patient transmission of HCV have been reported previously.[vi] ,[vii] As a consequence guidelines have been issued, asking for the use of a pleated hydrophobic breathing system filter, which can stop the passage of liquid borne HCV between the patients and the breathing system.[viii] In this context it is noteworthy that Pall Breathing System Filters containing the proprietary high efficiency hydrophobic filter medium have been validated to retain the Hepatitis C virus.[ix]
References:
[i] Fleurence RL, Collins FS A National Hepatitis C Elimination Program in the United States. A Historic Opportunity. JAMA.?2023;329(15):1251-1252
[iii] Owens DK et al., US Preventive Services Task Force. Screening for Hepatitis C Virus Infection in Adolescents and Adults US Preventive Services Task Force Recommendation Statement. JAMA.?2020;323(10):970-975
[iv] Beld M. et al., Different Hepatitis C Virus (HCV) RNA Load Profiles Following Seroconversion among Injecting Drug Users without Correlation with HCV Genotype and Serum Alanine Aminotransferase Levels. J Clin Microbiol. ?1998 Apr; 36(4): 872–877.
[v] Ciesek S. et al. How Stable Is the Hepatitis C Virus (HCV)? Environmental Stability of HCV and Its Susceptibility to Chemical Biocides; Journal of Infectious Diseases 2010; 201(12):1859–1866
[vi] Chant K. et al. (1994). Investigation of possible patient-to-patient transmission of hepatitis C in a hospital. New South Wales Public Health Bulletin 5; 47-51
[vii] Heinsen A. et al. (2000). A phylogenetic analysis elucidating a case of patient-to-patient transmission of hepatitis C virus during surgery. J Hosp Inf; 46:309-313
[viii] AAGBI Bloodborne virus advisory panel (1996). Possible transmission of Hepatitis C virus (HCV) via the anaesthetic breathing system
[ix] Lloyd G et al. Barriers to Hepatitis C Transmission within Breathing Systems: Efficacy of a Pleated Hydrophobic Filter Anaesthesia and Intensive Care (1997); 25: 235-238
Author:
Dr. Wolfgang Hares, MSc PHD- Sr. Global Manager Scientific Affairs for Gas Filtration and Respiratory Care
He supports with a range of products, which includes filters for mechanical ventilation, surgical and medical gas applications, and pulmonary function testing. He has held several roles in regional and Global marketing functions and holds a MsSc from the University of Cologne and a PhD in Biochemistry from the University Hamburg, Germany.
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