Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group

The isolation of anti-hepatitis C virus (HCV) in hemodialyzed (HD) patients has been repeatedly advocated to prevent nosocomial HCV transmission. We evaluated the incidence of seroconversion for HCV in Belgian HD patients, and demonstrate the complete prevention of HCV transmission 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 tested by a second or third generation enzyme-linked immunosorbent assay (with confirmation by a second- or third-generation recombinant immunoblot assay or the polymerase chain reaction) every 18 months from May 1991 to November 1995. Follow-up was available in 488 patients (drop-outs resulting from death or transplantation mainly). The yearly incidence of seroconversion for HCV over the initial 18 months was 1.41%, with evidence suggestive of nosocomial HCV transmission. Universal precautions were therefore reinforced. The incidence of seroconversion subsequently fell to 0.56% and 0%, respectively (P = 0.014), despite the facts that the average transfusion load and the proportion of patients with dialyzer reuse or with monitors disinfected after each session did 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.