Hepatitis C Virus Infections from Unsafe Injection Practices at an Endoscopy Clinic in Las Vegas, Nevada, 2007–2008

Clinical Infectious Diseases 2010;51:267–273
© 2010 by the Infectious Diseases Society of America.
All rights reserved.
1058-4838/2010/5103-0003$15.00
DOI: 10.1086/653937

Gayle E. Fischer, Melissa K. Schaefer, Brian J. Labus, Lawrence Sands, Patricia Rowley, Ihsan A. Azzam, Patricia Armour, Yury E. Khudyakov, Yulin Lin, Guoliang Xia, Priti R. Patel, Joseph F. Perz, and Scott D. Holmberg

Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, and Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and Southern Nevada Health District and Southern Nevada Public Health Laboratory, Las Vegas, and Nevada State Health Division, Carson City

Background. In January 2008, 3 persons with acute hepatitis C who all underwent endoscopy at a single facility in Nevada were identified.

Method. We reviewed clinical and laboratory data from initially detected cases of acute hepatitis C and reviewed infection control practices at the clinic where case patients underwent endoscopy. Persons who underwent procedures on days when the case patients underwent endoscopy were tested for hepatitis C virus (HCV) infection and other bloodborne pathogens. Quasispecies analysis determined the relatedness of HCV in persons infected.

Results. In addition to the 3 initial cases, 5 additional cases of clinic‐acquired HCV infection were identified from 2 procedure dates included in this initial field investigation. Quasispecies analysis revealed 2 distinct clusters of clinic‐acquired HCV infections and a source patient related to each cluster, suggesting separate transmission events. Of 49 HCV‐susceptible persons whose procedures followed that of the source patient on 25 July 2007, 1 (2%) was HCV infected. Among 38 HCV‐susceptible persons whose procedures followed that of another source patient on 21 September 2007, 7 (18%) were HCV infected. Reuse of syringes on single patients in conjunction with use of single‐use propofol vials for multiple patients was observed during normal clinic operations.

Conclusions. Patient–to‐patient transmission of HCV likely resulted from contamination of single‐use medication vials that were used for multiple patients during anesthesia administration. The resulting public health notification of 50,000 persons was the largest of its kind in United States health care. This investigation highlighted breaches in aseptic technique, deficiencies in oversight of outpatient settings, and difficulties in detecting and investigating such outbreaks.

Received 17 December 2009; accepted 31 March 2010; electronically published 24 June 2010.

Reprints or correspondence: Dr Gayle E. Fischer, Div of Viral Diseases, Mailstop A34, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333 (fez7@cdc.gov).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

http://www.journals.uchicago.edu/doi/abs/10.1086/653937