Professional Chronic C Hepatitis at a nurse - Case report

Introduction
A female patient, 42 y.o., nurse in a dialysis center, reports in March 2010, a prick accident with a needle from a patient with chronic C hepatitis (VHC).

Methods
The patient had no significant family and personal medical history. Soon after accident, the occupational medicine specialist investigated the case. Blood samples were taken (CBC, liver tests, viral antigenes) and all were normal. They were repeated after 1, 3, 6, 12 months since the accident. Anti-HCV antibodies turned positive starting from the 3rd month after the needle-prick and they were confirmed by the HCV-RNA test (qualitative and quantitative). Liver function showed a mild inflammatory process; all other lab tests were standing, in normal ranges.

Results
It was declared as a professional VHC and the patient was guided to an infectious hospital for monitoring. No recommendation for IFN treatment was made, because of the low number of viral RNA particles in the blood, the decreased inflammatory liver process and the good general status (with no signs/ symptoms for a chronic liver disease). The patient changed the work place in a department with no bleeding procedures and she is still monitored every 3 months, combined with psychological support.
al support.

Discussion
This is a typical professional skin contamination, with a needle from a patient caring a biological pathogenic agent (Flaviviridae class virus with liver tropism), to a patient with high risk for contamination (bleeding procedures, handling contaminated materials). The patient denies: surgical, dental, piercing, transfusions maneuvers, the use of i.v. drugs, high risk sexual habits, previous episodes of viral hepatitis. Most of the time, the patients didn't wear gloves and the accident happened during the night shift (fatigue, lack of attention). The occupational medicine recommendations: permanent usage of personal protection equipment, constant liver and viral monitoring, regular training for prevention to exposure and infection at/with biological agents, psychological support.