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.
Methods
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.
Results
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.
Conclusions
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]
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Improper-Anesthesia-Practice-Causes-Hepatitis-Outb/ArticleNewsFeed/Article/detail/678422?contextCategoryId=45046
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
http://www.gastrojournal.org/article/S0016-5085%2810%2900486-5/fulltext >"
(registration, purchase required). -
Mod.CP]
