Hepatitis outbreaks linked to poor infection control

Here are some recent examples in the U.S.

There have been a number of hepatitis outbreaks in U.S. ambulatory settings in recent years, including one in 2002 that involved 100 hepatitis infections caused by one certified registered nurse anesthetist (CRNA) who reused needles and another outbreak of 99 hepatitis C cases also was caused by reused syringes.

Here is a nutshell look at the various cases:

  • Nineteen patients in New York City had acute HCV infection after undergoing endoscopic procedures at the same doctor's office from 2000 to 2001. Public health investigators found that the office used inappropriate infection control and injection practices and they determined the probable route of infection was the contamination of multiple-dose anesthesia medication vials.1
  • Another NYC infection outbreak involved 38 patients who were infected with acute hepatitis B virus (HBV) between 2000 and 2002. Investigators found that the patients had all received multiple injections of atropine, dexamethasone, and vitamin B12, which were drawn from multiple-dose vials into one syringe at one doctor's office. NYCDOH officials ordered the physician to stop administering injections, and four months later the physician retired and closed his office permanently.1
  • In 2002, the Oklahoma State Department of Health (OSDH) learned of six patients with acute HCV infection who had received treatment from the same pain clinic. State health investigators found that a CRNA at the clinic had reused needles and syringes during clinic sessions when administering sedation medications through heparin locks connected to intravenous cannulas. The OSDH closed the clinic and further investigation found 69 cases of HCV infection and 31 cases of HBV infection that were likely acquired at the clinic. The CRNA was fined $99,000, the state board of nursing revoked the CRNA's license.1
  • Also in 2000-2002, 99 patients of a hematology/oncology clinic in Nebraska had become infected with a rare hepatitis C genotype, which investigators connected to one patient with that same infection who had begun attending the clinic in March, 2000. Nebraska Health and Human Services System (NHHSS) investigators found that one health care worker was responsible for the outbreak. This person routinely used the same syringe to draw blood during medication infusions, and the health care worker used the same syringe to draw catheter-flushing solution from multiple-use 500-cc saline bags. In October, 2002, the clinic was closed.1
  • There also have been reports of HBV and HCV transmission from infected patients to other patients in an ambulatory health care setting, such as hemodialysis centers, due to cross- contamination of health care workers' hands, medications, medical equipment, devices, or environmental surfaces. For instance, one HBV outbreak involved acupuncture, and another outbreak involving 60 patients took place at a weight loss clinic after the administration of medications via a jet injector device.2

References

  1. Centers for Disease Control and Prevention. Transmission of hepatitis B and C viruses in outpatient settings — New York, Oklahoma, and Nebraska, 2000-2002. MMWR 2003; 52(38):901-904.
  2. Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis (Healthcare Epidemiology) 2004; 38(11): 1,592-1,598. Epub 2004 May 12.