July 27th, 2010
An investigation into a pair of hepatitis outbreaks in New York City has revealed that the same anesthesiologist was responsible for spreading 6 cases each of hepatitis B and C at a GI center in 2006 and 1 case of hepatitis C at another center the year before through the reuse of single-use vials of propofol.
The report, published in the July issue of the journal Gastroenterology, does not name the anesthesiologist, who practiced in 12 outpatient facilities in the city between December 2003 and May 2007, or the facilities involved. Investigators from the CDC as well as the city and state departments of health have contacted all 4,490 patients treated by the anesthesiologist.
None of the staff at the 2 facilities from which the outbreaks emerged were infected with hepatitis B or C, investigators say, and their endoscopes had been properly reprocessed. "The only common exposure among all infected patients in both offices was receiving propofol from one contract anesthesiologist," writes lead author Bruce Gutelius, MD, MPH, in the article, and that provider habitually reused single-dose vials of propofol. At 1 facility, the provider even saved a vial for reuse the following day.
The authors urge all GI physicians to keep an eye on and maintain high standards for the injection, medication handling and other infection control practices of all team members in the procedure rooms.
Kent Steinriede
Source
Multiple Clusters of Hepatitis Virus Infections Associated With Anesthesia for Outpatient Endoscopy Procedures
Gastroenterology
Volume 139, Issue 1 , Pages 163-170, July 2010
This work was presented at the Epidemic Intelligence Service Conference, April 16, 2008, in Atlanta, GA.
Bruce Gutelius, Joseph F. Perz, Monica M. Parker, Renee Hallack, Rachel Stricof, Ernest J. Clement Yulin Lin, Guo-Liang Xia, Amado Punsalang, Antonella Eramo, Marci Layton, Sharon Balter
Received 11 September 2009; accepted 22 May 2010. published online 29 March 2010.
Abstract
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
Conflicts of interest The authors disclose no conflicts.
Funding Primary support for this investigation was provided by the New York City Department of Health and Mental Hygiene, additional support was provided by the Emerging Infections Program Cooperative Agreement number 5U50/CC1223667 from the Centers for Disease Control and Prevention, and staff were funded by their primary institutions.
PII: S0016-5085(10)00486-5
doi:10.1053/j.gastro.2010.03.053
© 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
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