Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

Blood, Plasma Derivatives, Organs, Tissues, and Semen

Current practices that exclude blood, plasma, organ, tissue, or semen donors determined to be at increased risk for HCV by history or who have serologic markers for HCV infection must be maintained to prevent HCV transmission from transfusions and transplants ⁽¹⁾. Viral inactivation of clotting factor concentrates and other products derived from human plasma, including IG products, also must be continued, and all plasma-derived products that do not undergo viral inactivation should be HCV RNA negative by RT-PCR before release.

High-Risk Drug and Sexual Practices

Health-care professionals in all patient care settings routinely should obtain a history that inquires about use of illegal drugs (injecting and noninjecting) and evidence of high-risk sexual practices (e.g., multiple sex partners or a history of STDs). Primary prevention of illegal drug injecting will eliminate the greatest risk factor for HCV infection in the United States ⁽¹⁴⁴⁾. Although consistent data are lacking regarding the extent to which sexual activity contributes to HCV transmission, persons having multiple sex partners are at risk for STDs (e.g., HIV, HBV, syphilis, gonorrhea, and chlamydia). Counseling and education to prevent initiation of drug-injecting or high-risk sexual practices is important, especially for adolescents. Persons who inject drugs or who are at risk for STDs should be counseled regarding what they can do to minimize their risk for becoming infected or of transmitting infectious agents to others, including need for vaccination against hepatitis B ^{(144,145,146,147,148)}. Injecting and noninjecting illegal drug users and sexually active MSM also should be vaccinated against hepatitis A ⁽¹⁴⁹⁾.

Counseling of persons with potential or existing illegal drug use or high-risk sexual practices should be conducted in the setting in which the patient is identified. If counseling services cannot be provided on-site, patients should be referred to a convenient community resource, or at a minimum, provided easy-to-understand health-education material. STD and drug-treatment clinics, correctional institutions, and HIV counseling and testing sites should routinely provide information concerning prevention of HCV and HBV infection in their counseling messages. Based on the findings of multiple studies, syringe and needle-exchange programs can be an effective part of a comprehensive strategy to reduce the incidence of bloodborne virus transmission and do not encourage the use of illegal drugs ^{(150,151,152,153)}. Therefore, to reduce the risk for HCV infection among injecting-drug users, local communities can consider implementing syringe and needle-exchange programs.

Percutaneous Exposures to Blood in Health Care and Other Settings

Health-Care Settings

Health-care, emergency medical, and public safety workers should be educated regarding risk for and prevention of bloodborne infections, including the need to be vaccinated against hepatitis B ^{(154,155,156)}. Standard barrier precautions and engineering controls should be implemented to prevent exposure to blood. Protocols should be in place for reporting and follow-up of percutaneous or permucosal exposures to blood or body fluids that contain blood.

Health-care professionals responsible for overseeing patients receiving home infusion therapy should ensure that patients and their families (or caregivers) are informed of potential risk for infection with bloodborne pathogens, and should assess their ability to use adequate infection-control practices consistently ⁽⁸⁸⁾. Patients and families should receive training with a standardized curriculum that includes appropriate infection-control procedures, and these procedures should be evaluated regularly through home visits.

Currently, no recommendations exist to restrict professional activities of health-care workers with HCV infection. As recommended for all health-care workers, those who are HCV-positive should follow strict aseptic technique and standard precautions, including appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments ^(154,155).

In chronic hemodialysis settings, intensive efforts must be made to educate new staff and reeducate existing staff regarding hemodialysis-specific infection-control practices that prevent transmission of HCV and other bloodborne pathogens ^(65,157). Hemodialysis-center precautions are more stringent than standard precautions. Standard precautions require use of gloves only when touching blood, body fluids, secretions, excretions, or contaminated items. In contrast, hemodialysis-center precautions require glove use whenever patients or hemodialysis equipment is touched. Standard precautions do not restrict use of supplies, instruments, and medications to a single patient; hemodialysis-center precautions specify that none of these items be shared among any patients. Thus, appropriate use of hemodialysis-center precautions should prevent transmission of HCV among chronic hemodialysis patients, and isolation of HCV-positive patients is not necessary or recommended.

Other Settings

Persons who are considering tattooing or body piercing should be informed of potential risks of acquiring infection with bloodborne and other pathogens through these procedures. These procedures might be a source of infection if equipment is not sterile or if the artist or piercer does not follow other proper infection-control procedures (e.g., washing hands, using latex gloves, and cleaning and disinfecting surfaces).