Published Date: 2008-02-28 18:00:17
Subject: PRO/EDR> Hepatitis B & C, HIV, nosocomial (02): USA (NV)
Archive Number: 20080228.0809
HEPATITIS B & C, HIV, NOSOCOMIAL (02): USA (NEVADA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 28 Feb 2008
Source: South Nevada Health District, press release [abbrv., edited]
The Southern Nevada Health District is advising patients who received
injected anesthesia medication at the Endoscopy Center of Nevada (700
Shadow Lane) of a risk for possible exposure to hepatitis C and other
bloodborne pathogens. The health district is recommending that
patients who had procedures requiring injected anesthesia at the
clinic between March 2004 and 11 Jan 2008 contact their primary care
physicians or health care providers to get tested for hepatitis C as
well as hepatitis B and HIV.
The health district received notification of 3 acute cases of
hepatitis C in January 2008 and has identified a total of 6 cases to
date; 5 of the cases had procedures requiring injected anesthesia
on the same day. Following a joint investigation with the Nevada
State Bureau of Licensure and Certification (BLC) and with
consultation from the Centers for Disease Control and Prevention, the
health district determined that unsafe injection practices related to
the administration of anesthesia medication might have exposed
patients to the blood of other patients. The exposures did not result
from the [other] medical procedures performed.
The cluster of illnesses came to the attention of the health district
in January 2008. These cases were reported to the health district by
area physicians. Nevada law requires that medical providers notify
public health officials when they identify a number of different
diseases, including hepatitis C. The common link between cases was
identified through the routine investigation of the cases reported by
medical providers, which includes an interview of the patient. Most
people infected with hepatitis C virus do not develop symptoms and do
not know that they have been infected. As a result, these infections
would not have been reported to the health district. An infection
with hepatitis C that results in the patient developing symptoms
(acute disease) is rare, so it is an unusual occurrence that brought
this problem to the attention of the health district. On average, 2
cases of acute hepatitis C are reported each year in Clark County;
6 cases have been identified in relation to this investigation.
A syringe (not a needle) that was used to administer medication to a
patient was reused on the same patient to draw up additional
medication. The process of redrawing medication using the same
syringe could have contaminated the vial from which the medicine was
drawn with the blood of the patient. The vial, which was not labeled
for use on multiple patients, was then used for a 2nd patient (with a
clean needle and syringe). If that vial was contaminated with the
blood of the 1st patient, any subsequent patients given medication
from that vial could have been exposed to bloodborne pathogens. [At
this point in the original text, the process of contamination is
illustrated by downloadable diagram. - Mod.CP]
Of the 6 known cases, 5 had procedures on the same day. Genetic
testing on 4 of the cases from that day has identified they likely
came from a common source. The patient that had a procedure on a
different day does not share a common source as the other 4. This
indicates that the problem that allowed disease transmission to occur
was not a one-time event but had recurred over an extended period.
Investigation of the clinic practices identified common practices
that would allow disease to be transmitted in this manner.
The unsafe injection practices associated with these cases were
identified during the investigation conducted in mid-January 2008.
The injection practices that led to the exposure have been
corrected, so no new patient exposures should be occurring. As it can
take several months for the symptoms of hepatitis C to appear,
additional cases might be identified despite no ongoing transmission
of disease. The investigation revealed practices that could have
exposed patients to the blood of another patient.
Although hepatitis C was the focus of the investigation, hepatitis B
and HIV can be transmitted in the same manner. It is unknown how many
people were infected at the clinic. Hepatitis C, B and HIV are
routinely found in the population. A significant number of people
might have been infected prior to their procedure. Although testing
can determine whether a person is infected, it cannot determine the
source of the infection.
Hepatitis C, B or HIV can result in a range of disease severity and
can eventually result in death. It is important that patients speak
with a physician or health care provider if they have one of these
diseases. A physician will be able to address specific risks for
serious illness and develop a plan to monitor patients' health.
On average, 2 cases of acute hepatitis C are identified each year in
Clark County. Most people who become infected with hepatitis C
initially have mild or no symptoms and do not know that they have
been infected unless they are tested by a doctor. Only a small
percentage of people infected with hepatitis C develop acute disease
and have any outward signs of infection.
The Southern Nevada Health District is responsible for investigating
reports of illness in our community in order to take steps to protect
the health and well-being of the public. Once notified of a
reportable disease, the health district begins an investigation and
works with the appropriate agencies to address any issues identified
and make recommendations to help prevent this type of situation from
When proper injection practices are followed, medical procedures,
including colonoscopies or similar procedures, are generally safe.
All health care professionals and medical facilities should follow
safe injection practices and infection control procedures. Patients
can and should ask their medical providers about the practices used
in their facility.
Katharine Briller, RN
Harborview Medical Center
[This comprehensive statement answers the questions posed previously.
Readers should download the diagram from the original text to obtain
a graphic illustration of the deficient procedure. So far, the number
of patients developing hepatitis C disease has been small, but the
consequences of infection with hepatitis B virus and HIV may not be
apparent for many years and are a cause for concern. - Mod.CP]