This article was updated on May 29, 2019.

Inadequate sterilization of medical equipment and hospital workers’ hands was the primary cause of 69 dialysis patients becoming infected with hepatitis C (HCV) in eastern China’s Jiangsu province, China Central Television reported Monday.

The 50 men and 19 women infected at Dongtai People’s Hospital range in age from 26 to 77. All were screened and diagnosed from 161 dialysis patients three days after the first hepatitis C infection was detected on May 13, according to the report.

Local health authorities launched an investigation at the hospital following the first confirmed case. As of Tuesday, 16 health officials and medical staff have been held to varying degrees of accountability for the hospital-acquired infections, with punishments ranging from warnings to dismissals, CCTV said.

The 69 cases of “nosocomial infection resulting from negligent management” were confirmed Monday by the local government. The same notice said that three top administrators at Dongtai People’s Hospital had been removed from their posts and a wider investigation into the risk of nosocomial infection is currently being conducted throughout the city.

Founded in 1950 and affiliated with Nantong University, Dongtai People’s Hospital currently remains open. However, after the official investigation cited the hospital’s insufficient staffing for handling its dialysis machines and lack of separate dialysis spaces and equipment for patients with hepatitis as contributing factors to the infections, state broadcaster Voice of China reported Wednesday that the hospital’s dialysis center will be closed for a “complete rebuild,” and a new dialysis center will be operational at another Dongtai hospital later this week.

A staff member from Dongtai People’s Hospital’s administrative office refused to comment on the HCV infections on Monday, instead referring Sixth Tone to the hospital’s vice president, Yang Maocheng, whom she said was responsible for handling media requests pertaining to the case. Sixth Tone’s repeated phone calls to the number she provided for Yang went unanswered.

On Wednesday, however, Yang told Voice of China that 95% of the 69 people infected should not face health complications, adding that the patients will be observed over the next month to determine appropriate treatments.

Hepatitis is relatively prevalent in China. According to the World Health Organization, the country is home to around one-third of all hepatitis B carriers. Though less common, HCV can have similar health consequences to the A and B viruses, including liver disease that lasts only a few weeks to a chronic condition affecting the carrier for life. Over 185 million people around the world carry HCV, with the virus accounting for around 350,000 deaths each year.

Although HCV can be sexually transmitted or passed from an infected mother to her baby, the WHO says the most common means of transmission are injecting medicine using unsterilized equipment and receiving transfusions of unscreened blood and blood products.

From 1996 to 2016, 17 cases of HCV infections were reported in China, 10 of which were linked to dialysis, according to research cited by China Newsweek. In February 2016, 26 people were infected with HCV during dialysis at a county-level hospital in Shaanxi province.

A 51-year-old woman surnamed Cheng is one of the 447,000 people in China being treated with dialysis. Since 2008, when her kidneys began failing, she has required dialysis three or four times a week in the eastern city of Hangzhou. But after noticing that her local hospital didn’t seem to be treating hepatitis patients in a separate space from uninfected patients as is required, Cheng decided to travel to one of the best medical facilities in the city — the First Affiliated Hospital of Zhejiang University’s School of Medicine — even though it takes her at least 50 minutes by taxi to get there.

“To make sure it’s safe, I have to travel three times farther, incurring high travel expenses, to the largest dialysis center in the province. The process there is standardized,” Cheng told Sixth Tone. “It’s exhausting, but (nosocomial infection) will happen sooner or later if the hospital doesn’t follow the proper protocol.”

Dialysis isn’t the only source of hospital-acquired infections to make headlines in China recently. Earlier this month, five newborn babies died at a hospital in Guangdong province after contracting Echovirus 11, a fecal-oral intestinal virus to which babies and people with weakened immune systems are especially vulnerable.

Cheng Ting-yi, an expert in hospital management, told Sixth Tone in a previous interview that the likelihood of hospital-acquired infection can be reduced by rethinking the layout of certain wards — for example, a policy as simple as ensuring that infants and elderly people with chronic health problems are kept isolated from patients with contagious illnesses.

Editor: David Paulk.

(Header image: A dialysis machine at a hospital in Loudi, Hunan province, Feb. 2, 2010. VCG)