Professional Development

Large, healthcare-related hepatitis outbreaks traced to unsafe injection practices

Last Updated: 2003-09-25 14:36:58 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Four recent large outbreaks of hepatitis B (HBV) and hepatitis C (HCV) in outpatient settings in the U.S. could have been prevented by adherence to basic principles of aseptic technique, according to the Centers for Disease Control and Prevention.

The CDC advises that "healthcare-related transmission should be suspected when cases are detected among persons without traditional risk factors for infection."

The first HCV outbreak discussed in the CDC's Morbidity and Mortality Weekly Report for September 26 involved 12 patients who underwent endoscopy procedures within 3 days after a chronically infected patient. Follow-up testing by the New York State Department of Health revealed seven more cases of HCV probably acquired in the office since January 2000, when the office opened.

Dr. S. Balter, of the New York State Department of Health, and colleagues report that transmission probably resulted from contamination of multiple-dose anesthesia medication vials due to incorrect injection practices.

A different outbreak occurred in another private office in New York and included 38 patients diagnosed with HBV between 2000 and 2002. Again, disease transmission appeared to result from inappropriate injection practices.

Dr. Balter and colleagues report that 69 cases of HCV infection and 31 cases of HBV were probably acquired in an Oklahoma pain remediation clinic in 2002. The problem was traced to reuse of needles and syringes when administering sedation medications.

At a Nebraska hematology/oncology clinic, 99 patients with clinic-acquired HCV infection between 2000 and 2001 were identified. This outbreak appeared to be caused by routine use of the same syringe to draw blood from patients' central venous catheters and to draw catheter-flushing solution from bags used for multiple patients.

"Obvious breaches in very fundamental infection control technique led to these four huge outbreaks," co-author Dr. Ian Williams, of the CDC, told Reuters Health.

"In the Oklahoma outbreak, one of the staff members had a regular practice of filling a large syringe from single dose vials and using it on patient after patient after patient, injecting it into heparin locks," he added. "He did not understand that was a practice one shouldn't do. And in all four outbreaks, oversight was missing."

Dr. Williams pointed out that in private practices, the onus is on the physicians to provide basic education regarding infection control and aseptic technique for their staff members, and then to provide direct supervision to ensure those techniques are followed.

Mor Mortal Wkly Rep CDC Surveill Summ 2003;52:901-904.