BACKGROUND: 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 two 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 bloodborne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed.
RESULTS: Six cases of outbreak-associated HCV infection and six 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-use vial of propofol for multiple patients. Reuse of syringes to re-dose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission.
CONCLUSIONS: Twelve persons acquired HBV and HCV infections (six hepatitis C, five hepatitis B, and one coinfection) in two separate offices as a result of receiving anesthesia from Anesthesiologist 1. Gastroenterologists are urged to carefully review the injection, medication handling and other infection control practices of all staff under their supervision, including anesthesia services.