Background

Medico-legal conflicts arise when it is difficult to prove the cause of nosocomial infections.

Aim

To report an outbreak of patient-to-patient transmission of hepatitis C virus (HCV) through the repeated use of a multi-dose saline flask during the rinsing of central venous catheters.

Methods

Blood samples were taken from each patient for the comparative analysis of their HCV RNA strains. No samples were available for one patient who died before the investigation started. Despite the known lability of HCV RNA, the body was exhumed four months after burial and postmortem samples were collected. HCV RNA was extracted successfully from liver and spleen samples. Genotyping of all the HCV strains was performed by sequence analysis of the 5′NC untranslated region, the E1 core conserved region and the E1/E2 hypervariable region.

Findings

Forensic investigators retraced the route used by two ward nurses, when saline catheter flushes were given to 14 patients with each nurse administering to seven patients. The comparative phylogenetic analysis of all case strains identified the deceased patient as the source of contamination to five patients.

Conclusions

This study highlights the value of sequence analysis as a tool for solving medico-legal conflicts. The High Court of Justice found that a health worker's re-use of a contaminated needle resulted in the nosocomial transmission of HCV.

中文翻译：

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在挖掘出的尸体中检测到丙型肝炎病毒，确定了引起多种致命疾病的医院传播源

背景

当很难证明医院感染的原因时，就会产生法医冲突。

目的

通过冲洗中央静脉导管期间反复使用多剂量生理盐水瓶来报告丙型肝炎病毒（HCV）在患者之间的爆发。

方法

从每位患者中抽取血样用于他们的HCV RNA菌株的比较分析。在调查开始前没有一名患者死亡的样本。尽管已知HCV RNA的不稳定性，但在收集埋葬和死后样本四个月后才将尸体挖出。HCV RNA已成功从肝脏和脾脏样本中提取。通过对5'NC非翻译区，E1核心保守区和E1 / E2高变区进行序列分析，对所有HCV病毒株进行基因分型。

发现

法医调查员追溯了两名病房护士使用的路线，当时对14位患者进行了生理盐水冲洗，每位护士对7位患者进行了冲洗。对所有病例菌株进行的比较系统发育分析确定，死者是五名患者的污染源。

结论

这项研究强调了序列分析作为解决法医学冲突的工具的价值。高等法院发现，医务人员重复使用受污染的针头导致了丙型肝炎病毒在医院的传播。