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Investigation of the remaining 65 patients visited at the emergency room on that day disclosed that 8 patients had a positive anti-hepatitis C virus (anti-HCV) test and 4 of them had biochemical evidence of acute anicteric hepatitis. HCV RNA was detected in 12 of the 13 anti-HCV-positive patients. Phylogenetic analysis of the nonstructural 5A (NS5A) and E2 regions showed that 10 patients, including all 9 with acute hepatitis, were infected with a closely related HCV strain, while the remaining 2 patients harbored unrelated strains. Flushing of intravenous catheters with heparin retrieved from a multidose heparin solution in saline was carried out for all the patients involved in the hepatitis outbreak but in only 1 of 23 (4%) matched controls recruited among HCV-noninfected patients attending the emergency room on the same day, and this was the only significant difference concerning risk factors for HCV infection between patients and controls. Thus, accidental contamination of a multidose heparin solution with blood from an unrecognized HCV carrier was identified as the source of this nosocomial outbreak of hepatitis C.<\/jats:p>","DOI":"10.1128\/jcm.40.11.4363-4366.2002","type":"journal-article","created":{"date-parts":[[2002,10,30]],"date-time":"2002-10-30T20:42:12Z","timestamp":1036010532000},"page":"4363-4366","update-policy":"http:\/\/dx.doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":43,"title":["Outbreak of Nosocomial Hepatitis C Virus Infection Resolved by Genetic Analysis of HCV RNA"],"prefix":"10.1128","volume":"40","author":[{"given":"Miguel","family":"Bruguera","sequence":"first","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives, Hospital Cli\u0301nic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan-Carlos","family":"Saiz","sequence":"additional","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives, Hospital Cli\u0301nic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Franco","sequence":"additional","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives, Hospital Cli\u0301nic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireia","family":"Gime\u0301nez-Barcons","sequence":"additional","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives, Hospital Cli\u0301nic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose\u0301 Mari\u0301a","family":"Sa\u0301nchez-Tapias","sequence":"additional","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives, Hospital Cli\u0301nic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Fabregas","sequence":"additional","affiliation":[{"name":"Hospital de Figueres, Girona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roser","family":"Vega","sequence":"additional","affiliation":[{"name":"Hospital de Figueres, Girona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neus","family":"Camps","sequence":"additional","affiliation":[{"name":"Departament de Sanitat i Seguretat Social, Generalitat de Catalunya, Barcelona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Domi\u0301nguez","sequence":"additional","affiliation":[{"name":"Departament de Sanitat i Seguretat Social, Generalitat de Catalunya, Barcelona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lluis","family":"Salleras","sequence":"additional","affiliation":[{"name":"Departament de Sanitat i Seguretat Social, Generalitat de Catalunya, Barcelona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.1890430417"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/501765"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-99-3-330"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199707243370404"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410040030006"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(96)80020-1"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9071(199608)49:4<296::AID-JMV7>3.0.CO;2-Z"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340902"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(01)80579-1"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.87.24.9524"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199909100-00018"},{"key":"e_1_3_2_13_2","unstructured":"Krause G. 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