The Effectiveness of Bleach in the Prevention of Hepatitis C Transmission - Final Report

1. Introduction

a) Overview

Hepatitis C Virus (HCV) has infected approximately 170 million people worldwide, including an estimated 210,000 to 275,000 people in Canada - 0.8% of the Canadian population^1,2. HCV continues to infect 5,000 Canadians annually^3-5.

The most significant risk factors for HCV infection have been the receipt of blood products and injection drug use (IDU). The former has been all but resolved with universal blood screening methods introduced in 1990, but the latter is an ongoing problem. HCV is endemic among injection drug users, with over 80% infected in many IDU populations worldwide². HCV can also be transmitted sexually^6-8, during pregnancy and childbirth9,10, through other percutaneous exposures including occupational needle stick injuries^6,7, acupuncture, electrolysis, tattooing and body piercing^11,12 and by sharing contaminated personal hygiene items such as toothbrushes and razors^1,12. Overall, these modes of transmission are thought to represent less than 40% of HCV cases^1,6,13,14, whereas IDU accounts for 50% to 70% of current cases^1,2,15,16.

In an effort to interrupt the transmission of HCV - as well as other blood-borne pathogens such as the Human Immunodeficiency Virus (HIV) and hepatitis B virus (HBV) - harm reduction programs in Canada and worldwide have encouraged people who use injection drugs to use bleach to clean needles and syringes, if new needles are not available. However, there is little direct evidence demonstrating the effectiveness of bleach in preventing HCV transmission among these people.

This paper provides background on HCV infection and summarizes the literature regarding the use of bleach as a disinfectant for needles and syringes. It also looks at the comparative effectiveness of bleach as a disinfectant to prevent the transmission of HBV and HIV. Lastly, it draws some important prevention messages from harm reduction programs such as needle exchanges and makes recommendations regarding bleach promotion and general HCV prevention programs.

b) Methodology

This paper summarizes literature identified through Medline literature searches using the MeSH terms hypochlorite, hepatitis, bleach, prevention, substance, abuse, viruses and transmission. Further searches were done on Medline and other information sources for these topics as well as HIV, AIDS, IDU and all related topics. Other sources of information included non-peer reviewed information resources by government agencies, community groups and information displayed on the Internet.

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