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Women contract hepatitis C in surgery

Monday 7 May 2001

National infection control guidelines are to be toughened after two women contracted hepatitis C during routine surgery in Victorian hospitals.

The two incidents - one in 1996 and another in 1999 - are the first documented cases of person-to-person transmission of hepatitis C through surgery in the state.

They happened during arthroscopy and colonoscopy operations at separate  hospitals, one in regional Victoria, and infection control experts blame  cost- saving for the breaches.

"Cost has inspired this breach in protocol, nothing else," said Greg  Knoblanche, the infection control spokesman for the Australian and New Zealand College of Anaesthetists. 

Health officials believe the infections were caused by contamination of anaesthetic fluid with infected blood after multiple patients were treated from one anaesthetic vial, against the recommendations of the guidelines. 

After lengthy investigations into the infection control breaches, the Department of Human Services believes they occurred in similar circumstances and were caused by the same lapse in procedure.

In both cases, the women had surgery immediately after intravenous drug users, who were later found to be carrying hepatitis C.

The incidents, which have not previously been publicised, have ignited debate within the medical community about the use of so-called "multi-dose vials", with some experts calling for them to be banned. 

The cases have led the National Health and Medical Research Council to tackle the issue as they rewrite their infection control guidelines to further restrict the use of the vials.

Department of Human Services manager of communicable diseases John Carnie said the cases had thankfully been picked up soon after the women contracted the disease.

One woman began to show symptoms of hepatitis C three months after a colonoscopy. The other was picked up in screening tests when she went to donate blood six months after an arthroscopy. 

Dr Carnie said health officials began to investigate when the women showed no significant risk factors for hepatitis C, leaving their surgery as the only chance they had to contract the disease. After checking patient records investigators discovered that intravenous drug users carrying hepatitis C had surgery immediately before the women.

Investigators audited all aspects of the operating procedure. They found no common instruments were used in either operation, but vials of intravenous anaesthetic had been used on multiple patients. Further genetic profiling tests in both cases revealed the type of hepatitis C the women had contracted was almost identical to the carriers.

Dr Carnie said current NHMRC guidelines recommend that one single-dose  anaesthetic vial be used per patient. But some hospitals still use anaesthetic from the same vial on more than one patient.

The potential for cross-infection occurs when the surgical team changes the needles but not the vial holding the anaesthetic.

The Age Melbourne Australia