Hepatitis C Virus Infections from Unsafe Injection Practices at an Endoscopy Clinic in Las Vegas, Nevada, 2007-2008
Hepatitis C Virus Infections from Unsafe Injection Practices at an Endoscopy Clinic in Las Vegas, Nevada, 2007-2008
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DOI：
10.1086/653937
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发表时间：
2010-08-01
影响因子：
11.8
通讯作者：
Holmberg, Scott D.
中科院分区：
文献类型：
--
作者：
Fischer, Gayle E.;Schaefer, Melissa K.;Holmberg, Scott D.
背景。 2008 年 1 月，确定了 3 名急性丙型肝炎患者，他们都在内华达州的一家机构接受了内窥镜检查。方法。我们回顾了最初发现的急性丙型肝炎病例的临床和实验室数据，并回顾了病例患者接受内窥镜检查的诊所的感染控制实践。对病例患者接受内窥镜检查当天接受手术的人员进行了丙型肝炎病毒（HCV）感染和其他血源性病原体检测。准种分析确定了感染者中 HCV 的相关性。结果。除了最初的 3 例病例外，在初步现场调查的 2 个手术日期中还发现了另外 5 例临床获得性 HCV 感染病例。准种分析揭示了 2 个不同的临床获得性 HCV 感染群以及与每个群相关的来源患者，表明存在单独的传播事件。 2007 年 7 月 25 日，49 名 HCV 易感者按照来源患者的程序接受治疗，其中 1 名 (2%) 感染了 HCV。 2007 年 9 月 21 日，在 38 名丙肝病毒易感者中，按照另一名来源患者的程序进行了治疗，其中 7 人（18%）感染了丙肝病毒。在正常的临床操作过程中，观察到对单个患者重复使用注射器以及对多个患者使用一次性丙泊酚小瓶的情况。结论。丙型肝炎病毒在患者之间的传播可能是由于麻醉期间用于多个患者的一次性药物瓶受到污染造成的。由此产生的公共卫生通知涉及约 50,000 人，是美国医疗保健领域同类中规模最大的一次。这项调查突显了无菌技术的违规、门诊环境监管的缺陷以及发现和调查此类疫情的困难。
Background. In January 2008, 3 persons with acute hepatitis C who all underwent endoscopy at a single facility in Nevada were identified.Method. We reviewed clinical and laboratory data from initially detected cases of acute hepatitis C and reviewed infection control practices at the clinic where case patients underwent endoscopy. Persons who underwent procedures on days when the case patients underwent endoscopy were tested for hepatitis C virus (HCV) infection and other bloodborne pathogens. Quasispecies analysis determined the relatedness of HCV in persons infected.Results. In addition to the 3 initial cases, 5 additional cases of clinic-acquired HCV infection were identified from 2 procedure dates included in this initial field investigation. Quasispecies analysis revealed 2 distinct clusters of clinic-acquired HCV infections and a source patient related to each cluster, suggesting separate transmission events. Of 49 HCV-susceptible persons whose procedures followed that of the source patient on 25 July 2007, 1 (2%) was HCV infected. Among 38 HCV-susceptible persons whose procedures followed that of another source patient on 21 September 2007, 7 (18%) were HCV infected. Reuse of syringes on single patients in conjunction with use of single-use propofol vials for multiple patients was observed during normal clinic operations.Conclusions. Patient-to-patient transmission of HCV likely resulted from contamination of single-use medication vials that were used for multiple patients during anesthesia administration. The resulting public health notification of similar to 50,000 persons was the largest of its kind in United States health care. This investigation highlighted breaches in aseptic technique, deficiencies in oversight of outpatient settings, and difficulties in detecting and investigating such outbreaks.