9 de agosto de 2010

Alerta: Hepatitis C Virus Transmission at an Endoscopy Clinic

Eight cases were identified; contamination and reuse of open propofol vials was the likely source.

Hepatitis C is the most common bloodborne infection in the U.S. Although nosocomial transmission of hepatitis C virus (HCV) is considered rare, the number of cases associated with nonhospital medical settings is increasing. Now, researchers describe an outbreak of HCV infection at an endoscopy clinic.
During a 5-week period in 2007, three patients developed acute hepatitis after undergoing endoscopy at a single clinic in Las Vegas. Among the 123 additional patients who underwent endoscopy at that clinic on the same dates as these individuals, 6 were known to be HCV infected and were considered potential source patients; the remaining 117 were advised to undergo screening for antibodies to HCV. This testing identified an additional five patients who met the case definition for clinic-acquired HCV infection.
Genetic analysis of the HCV from the eight patients with clinic-acquired infections and from the six patients known to have been infected before their procedures allowed the identification of the source patient for each endoscopy date. Among HCV-susceptible individuals who underwent endoscopy after the source patients, HCV infection developed in 1 of 49 (2%) whose procedures occurred on the first date and in 7 of 38 (18%) whose procedures occurred on the second date. During the investigation, an anesthetist was observed placing a new needle on a syringe, then refilling the syringe from a propofol vial that was intended for single use but had been used for other patients.

Comment: This outbreak of HCV infection was likely related to contamination of open propofol vials through refilling of syringes that had become contaminated with the source patients' blood. This practice was routine in the clinic, so it is surprising that more infections did not occur.

— Neil M. Ampel, MD
Published in Journal Watch Infectious Diseases July 21, 2010

Citation(s):Fischer GE et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007–2008. Clin Infect Dis 2010 Aug 1; 51:267.

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