Hepatitis C virus (HCV) transmission from healthcare exposure has been documented before in various healthcare settings, with many of these outbreaks attributed to unsafe injection practices. A case published in a recent Morbidity and Mortality Weekly Report (MMWR) demonstrates why infection control guidelines are important in all healthcare settings, including those where complementary and alternative medicine therapies (CAM) are practiced. 

The patient at the center of this case was a frequent blood donor who was first alerted to his HCV-positive status by the blood bank where he went to make donations; he was asymptomatic and had no traditional risk factors for HCV infection. After conducting an investigation into the donor’s healthcare exposures and other potential risks, it was noted that the patient had recently received an injection procedure as part of prolotherapy at a clinic. 

Prolotherapy is an injection-based CAM therapy used to treat musculoskeletal pain; it is also known as regenerative injection therapy. Substances typically used in the injection include hypertonic dextrose, phenol-glycerine-glucose, and morrhuate sodium, a mixture of fatty acids from cod liver oil. Some patients may also receive platelet rich plasma therapy which involves injection of autologous blood with a high platelet-to-plasma ratio. No formal training is needed to deliver prolotherapy, nor have practice guidelines been established.