BACKGROUND: Hepatitis C virus infection (HCV) is not infrequent among 
haemodialysis patients. Most published reports suggest that patient-to-patient 
spread, either directly or indirectly, is the most common mode of transmission 
in renal units.
AIM: To investigate the source of an outbreak, and the route of transmission, of 
acute HCV infection in two Scottish patients occurring within eight weeks of 
receiving haemodialysis in the same unit while on holiday in Majorca.
METHODS: This was an international epidemiological and molecular investigation 
of HCV infection among a cohort of haemodialysis patients from nine countries.
FINDINGS: No further HCV-positive infections were observed among residents and 
holidaymakers receiving haemodialysis at the unit in Majorca. Molecular 
investigations confirmed that a Spanish healthcare worker (HCW) was the source 
of infection for the two Scottish patients. The investigators were unable to 
determine the route of transmission.
CONCLUSIONS: This outbreak is the first reported case of HCW-to-patient 
transmission of HCV in a renal unit, and the third reported case of transmission 
involving a HCW who had not performed invasive procedures. The issue of whether 
renal units are an exceptional case with regards to the risk of transmission 
associated with non-invasive procedures should be considered, in conjunction 
with the need to improve surveillance of blood-borne virus transmissions in 
renal units in the UK and abroad.