Hepatitis C
Investigation
UPDATE:
"Patients
were put at risk, health officials say, when a syringe would
be reused on an infected patient and then used to draw
anesthesia from vials intended for just one patient. The
vials would then be used on other patients, potentially
spreading disease."
Oct. 06, 2008
Copyright © Las Vegas Review-Journal
[...]have received word that
40,000 patients of a
Las Vegas Endoscopy Clinic will be receiving
letters telling them they are at risk and to get tested
for Hepatitis C and other diseases. There have been a
half-dozen cases reported prior to the large-scale
patient notification that was just announced moments
ago. The joint investigation
identified the re-use of syringes (not needles) and the
use of single dose vials of anesthesia medication on
multiple patients as the potential sources of
contamination.
The Southern
Nevada Health District has posted additional information
on its website at
www.SouthernNevadaHealthDistrict.org .
http://www.southernnevadahealthdistrict.org/outbreaks/index.htm
Hepatitis C
Investigation
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 patients who had procedures requiring
injected anesthesia at the clinic between March 2004 and
January 11, 2008, contact their primary care physicians
or health care providers to get tested for hepatitis C
as well as hepatitis B and HIV.
Why is the health district
making these recommendations?
- The health district received notification of
three acute cases of
hepatitis C in
January 2008 and has identified a total of six cases
to date. Five 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 medical
procedures performed.
How were the
cases discovered?
- 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.
Why did it take several months
for this to come to the attention of the health
district?
- 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, two cases of acute hepatitis C are
reported each year in Clark County. Six cases have
been identified in relation to this investigation.
How were patients exposed?
- 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 second
patient (with a clean needle and syringe).
- If that vial was contaminated with the blood of
the first patient, any subsequent patients given
medication from that vial could have been exposed to
bloodborne pathogens.
How did you determine the link between these
cases?
- Of the six known cases, five had procedures on
the same day. Genetic testing on four 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
four. This indicates the problem that allowed
disease transmission to occur was not a one-time
event, but had recurred over an extended period of
time.
- Investigation of the clinic practices identified
common practices, which would allow disease to be
transmitted in this manner.
What actions have been taken to
correct the unsafe injection control practices?
- The unsafe injection practices associated with
these cases were identified during the investigation
conducted in mid-January. The injection practices
that lead 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.
Who performed the investigation?
- The response was led by the Southern Nevada
Health District, and the team included members of
the Nevada State Bureau of Licensure and
Certification and the Centers for Disease Control
and Prevention.
Why is the health district also
recommending testing for hepatitis B and HIV?
- 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.
How many people will be
diagnosed with hepatitis C, B or HIV from this
investigation?
- 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 if a
person is infected, it cannot determine the source
of the infection.
How serious are these illnesses?
- 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 you have one of
these diseases. A physician will be able to address
specific risks for serious illness and develop a
plan to monitor your health.
How many cases of hepatitis C
are reported to the health district each year?
- On average, two 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.
What is the Southern Nevada
Health District’s role in the response?
- 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 occurring again.
As a patient how can I protect
myself when getting these types of medical procedures?
- It is important to remember the transmission of
the disease in these cases were not related to the
medical procedures, but rather to the anesthesia
administered to the patient.
- 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.
Are these types of medical
procedures safe?
- Preventive medical procedures are an important
part of protecting yourself against the development
of diseases, including cancer. If recommended by
your physician, there is no reason why you should
avoid undergoing these types of medical procedures.
- Although this investigation focused on a center
that performed endoscopies, the source of the
exposure was the way the anesthesia was
administered.
What is being done to prevent
this from happening again?
- The Southern Nevada Health District, the Nevada
State Health Division and the Bureau of Licensure
and Certification are providing technical bulletins
and educational materials to medical facilities and
providers in an effort to educate the health care
community and prevent these types of incidents from
happening in the future.
What are the recommendations for
people who test positive for hepatitis C, B or HIV?
- Options for disease management and possible
treatment options, as well as regular health
monitoring, should be discussed with a physician,
who can determine the appropriate next steps for the
patient.
