A Used Ball of Cotton Wool as a Source of Nosocomially-Acquired Hepatitis C Infection

Background and Aims:  An error involving the reuse of the same ball of cotton wool in stopping blood flow after venous blood collection from five antenatal women prompted further investigation and follow-up studies to rule out nosocomially- acquired blood borne viruses.

Methods: The five women were screened for antibodies to the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B surface antigen (HBsAg), using enzyme-linked immunosorbent assay (ELISA) /kits Murex HIV-1,2,0 (Murex Biotech, UK); ORTHO HCV 3.0 ELISA Test kit (Ortho Clinical Diagnostics, USA); and QUADRATECH CHECK 4-HBs one-step generation test kit (VEDALAB, France) respectively. The tests were repeated in 2005 on the five women, their husbands and twenty children, aged nine months to seven years borne by all the women within the period.

Anti-HCV was detected in one out of the five women at the initial stage of the error (1997). No anti-HIV or HBsAg was found in any of the women. A repeat screening for anti-HIV, anti-HCV and HBsAg carried out seven years later (2005) on the five women, their husbands and twenty children aged nine months to seven years borne by all the women within the seven years revealed an HCV sero-conversion in two additional women. No anti-HCV or anti-HIV nor HBsAg was detected in any of the women, their spouses or their 20 offspring.

Results: Anti-HCV was detected in one out of the five women at the initial stage of the error (1997). No anti-HIV or HBsAg was detected in any of the women. A repeat re-evaluation revealed an HCV sero-conversion in two additional women. No anti-HCV or anti-HIV nor HBsAg was detected in any of the women, their spouses or any of their 20 screened offspring.

Conclusions: This study provides evidence for the nosocomial transmission of HCV through the use of a contaminated ball of cotton wool. It also confirms the poor efficiency of sexual and vertical transmission of HCV and calls for improved hospital facilities and the use of skilled staff to perform essential duties.