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Multiple Clusters of Hepatitis Virus Infections Associated With Anesthesia for Outpatient Endoscopy Procedures
This work was presented at the Epidemic Intelligence Service Conference, April 16, 2008, in Atlanta, GA.

Bruce Gutelius

Background & Aims
Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted during administration of intravenous anesthesia when medication vials are used for multiple patients using incorrect technique. We investigated an outbreak of acute HBV and HCV infections among patients who received anesthesia during endoscopy procedures from the same anesthesiologist (anesthesiologist 1), in 2 different gastroenterology clinics.

Chart reviews, patient interviews, clinic site visits and infection control assessments, and molecular sequencing of patient isolates were performed. Patients treated by anesthesiologist 1 on specific procedure days were offered testing for blood-borne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed.

Six cases of outbreak-associated HCV infection and 6 cases of outbreak-associated HBV infection were identified in clinic 1. One outbreak-associated HCV infection was identified in clinic 2. HCV quasispecies sequences from the patients were nearly identical (96.9%–100%) to those from source patients with chronic viral hepatitis. All affected patients in both clinics received propofol from anesthesiologist 1, who inappropriately used a single-patient-use vial of propofol for multiple patients. Reuse of syringes to redose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission.

Twelve persons acquired HBV and HCV infections (6 hepatitis C, 5 hepatitis B, and 1 coinfection) in 2 separate offices as a result of receiving anesthesia from anesthesiologist 1. Gastroenterologists are urged to review carefully the injection, medication handling, and other infection control practices of all staff under their supervision, including providers of anesthesia services.

Keywords: Hepatitis, Outbreak, Infection Control

Abbreviations used in this paper: DOHMH, New York City Department of Health and Mental Hygiene, E1-HVR1, hypervariable region 1 of the E2 gene, HBV, hepatitis B virus, HCV, hepatitis C virus, HIV, human immunodeficiency virus, IV, intravenous



ModernMedicine, HealthDaily News [edited]    

Improper Anesthesia Practice Causes Hepatitis Outbreak
An anesthesiologist who reused a contaminated single-use propofol
vial on multiple endoscopy patients caused an outbreak of hepatitis
infection affecting 13 patients at 2 clinics, according to a report
published in the July 2010 issue of Gastroenterology. [Propofol is a
drug used to induce or maintain anesthesia during certain surgeries,
tests, or procedures. - Mod.CP]

Bruce Gutelius, M.D., of the U.S. Centers for Disease Control and
Prevention (CDC) in Atlanta, and colleagues [reference below]
investigated outbreaks of hepatitis B virus (HBV) and hepatitis C
virus (HCV) infections among patients at the 2 clinics who had
received anesthesia from the same anesthesiologist. The investigators
reviewed medical charts, conducted patient interviews and site
visits, and performed infection control assessments. The
investigators also did molecular sequencing of available patient isolates.

At one clinic, the researchers identified 6 cases of HCV infection
and 6 cases of HBV infection, and at the other clinic, one case of
HCV infection; all the cases were associated with the outbreak. HCV
quasispecies sequences from the patients were found to be nearly
identical (96.9 to 100 percent) to those from the patients considered
to be the infection source. The investigators write that the
anesthesiologist used a single-use vial of propofol on multiple
patients, and conclude that the likely cause of the viral
transmission was the reuse of syringes to re-dose patients, which
contaminated the vials for later patients.

"Gastroenterologists are urged to review carefully the injection,
medication handling, and other infection control practices of all
staff under their supervision, including providers of anesthesia
services," the authors write.


[Nosocomial transmission of hepatitis B and hepatitis C virus
infections have occurred frequently in the United States and
elsewhere as a result of medical negligence, most frequently in
association with haemodialysis. The incident described above involves
anesthesia and multiple use of a single-use vial during endoscopy. It
is presumed to refer to events 1st described in the ProMED-mail post
titled: "Hepatitis C, physician-associated cluster - USA (NY)
20070616.1965," and subsequently.

The reference for the Gastroenterology paper on which the above
report is based is the following: "Multiple Clusters of Hepatitis
Virus Infections Associated With Anesthesia for Outpatient Endoscopy
Procedures. B. Gutelius and others, Gastroenterology Volume 139,
Issue 1, Pages 163-170, July 2010 >"
(registration, purchase required). - Mod.CP]