In December this blog put together three case scenarios where hepatitis C was transmitted to patients through infected healthcare workers while undergoing medical procedures at the following facilities, Rose Medical Center, Mayo and Riverside Regional. In all three outbreaks infected employees admitted to stealing syringes filled with Fentanyl and injecting themselves with the drug replacing the syringes with saline to be used on future patients.
The Risk - Contracting Hepatitis C In A Nonhospital Setting
In the United States the risk for contracting hepatitis C while undergoing medical procedures at a nonhospital medical setting is rare. However, it's been reported over the last few years that at free-standing clinics for colonoscopies and dialysis its increasing.
I have summarized a few of the recent hepatitis C outbreaks at these facilities. When we break down these patterns three common factors are present. The first factor of the pattern is route of transmission. In most clinical transmissions the route of transmission is an irresponsible healthcare provider. The pattern continues with a second common factor, the affliction of drug addiction plaguing the previously mentioned healthcare provider. This catalyst leads to the third and final factor of the pattern, the point of origin of the outbreak. In the majority of the scenarios we are examining the drug or anesthetic administered is contaminated due to human error. This is a clear cycle of negligence that perpetuates itself time and time again.Continue Reading Here
Original Research - Annals of Internal Medicine
Health Care–Associated Hepatitis C Virus Infections Attributed to Narcotic Diversion
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Walter C. Hellinger, MD;Laura P. Bacalis, RN;Robyn S. Kay, MPH;Nicola D. Thompson, PhD, MS; Guo-Liang Xia, MD, MPH;Yulin Lin, MD;Yury E. Khudyakov, PhD; and Joseph F. Perz, DrPH
Context - Hepatitis C virus (HCV) infection acquired in health care settings is usually due to breaches in infection control.
Contribution - Three transplant patients were unexpectedly found to have incident HCV infection. The HCV identified in all 3 patients had close genetic relatedness to the HCV identified in a technician in an interventional radiology area where the patients had received fentanyl. The technician admitted to diverting fentanyl in a manner that could cause contamination of syringes used for patient care.
Nearly 4000 potentially exposed patients were screened, and 2 additional cases of HCV were identified.
Caution - Not all potentially exposed patients were tested.
Implication - Drug diversion can lead to HCV infection in the healthcare setting and may be difficult to detect.
—The EditorsAbstract
Background: Three cases of genetically related hepatitis C virus (HCV) infection that were unattributable to infection control breaches were identified at a health care facility.
Objective: To investigate HCV transmission from an HCV-infected health care worker to patients through drug diversion.
Design: Cluster and look-back investigations.
Setting: Acute care hospital and affiliated multispecialty clinic.
Patients: Inpatients and outpatients during the period of HCV transmission.
Measurements: Employee work and narcotic dispensing records, blood testing for HCV antibody and RNA, and sequencing of the NS5B gene and the hypervariable region 1 of the E2 gene.
Results: 21 employees were recorded as being at work or as retrieving a narcotic from an automated dispensing cabinet in an area where a narcotic was administered to each of the 3 case patients; all employees provided blood samples for HCV testing. One employee was infected with HCV that had more than 95% NS5B sequence homology with the HCV strains of the 3 case patients. Quasi-species analysis showed close genetic relatedness with variants from each of the case patients and more than 97.9% nucleotide identity. The employee acknowledged parenteral opiate diversion. An investigation identified 6132 patients at risk for exposure to HCV because of the drug diversion. Of the 3929 living patients, 3444 (87.7%) were screened for infection. Two additional cases of genetically related HCV infection attributable to the employee were identified.
Limitation: Of the living patients at risk for HCV exposure, 12.3% were not tested.
Conclusion: Five cases of HCV infection occurring over 3 to 4 years were attributed to drug diversion by an HCV-infected health care worker. Studies of drug diversion and assessments of strategies to prevent narcotics tampering in all health care settings are needed.
Unsafe Injection Practices Result in Transmission of Hepatitis C Virus
A recent article posted online ahead of print in the journal Hepatology by the CDC’s Dr. Joseph Perz identifies medical injections as a potential risk factor for having hepatitis B or hepatitis C infection.
In this week’s Annals of Internal Medicine, an editorial highlights how unsafe injection practices and other infection control breaches result in transmission of hepatitis C virus.
The editorial also mentions the need for the national One and Only Campaign led by the CDC and the Safe Injection Practices Coalition to promote safe injection practices and describes the increasing role of public health departments in healthcare-associated infection prevention.
This week, the One and Only Campaign announces the release of a new Health Department Toolkit that provides information and tips on ways to implement the One and Only Campaign.
Source:Mayo
Lessons Shared from Transmission of Hepatitis C Infection to Patients
An extensive investigation into hepatitis C infections in three transplant patients led investigators to uncover the route of transmission.
Tuesday, April 03, 2012
JACKSONVILLE, Fla. — Findings of an extensive investigation at Mayo Clinic, published in the April 3 issue of the Annals of Internal Medicine, serve as a warning to other health care institutions that drug diversion by a health care worker can spread hepatitis C, a potentially fatal viral infection, to patients.
The report details the effort that Mayo Clinic in Florida undertook to find the source of a genetically related hepatitis C virus that appeared in three patients over a 2 to 3 year period of time. Investigators eventually traced the source to a radiology technician who was using a portion of narcotics contained within syringes intended for patients, and then replacing the missing fluid with saline. The process contaminated the syringes with hepatitis C.
Mayo Clinic then identified 3,929 patients who were at risk for exposure to hepatitis C, and invited them to be screened. Of the 3,444 patients who were tested, two additional cases of genetically related hepatitis C infection attributed to the employee were identified.
The report, written by infectious disease experts and epidemiologists at Mayo Clinic, the Florida Department of Health, and the U.S. Centers for Disease Control and Prevention, is the most thoroughly documented instance of hepatitis C transmission caused by drug diversion in an American hospital or clinic, according to the report's lead author, Walter Hellinger, M.D., a health care epidemiologist.
Four other instances have been reported to date in the United States and, of these, only one in which narcotic diversion was suspected but not confirmed has been published in a peer-reviewed medical journal, he says.
"We owe our patients the best care possible, which meant conducting a thorough, investigation," says Dr. Hellinger, who also serves as chair of Infection Control at the Mayo Clinic campus in Florida.
"Based on our experience, health care institutions should realize this kind of hepatitis C transmission is possible," he says.
Dr. Hellinger also says that while some areas within hospitals are closely monitored for drug diversion — such as operating rooms — stronger efforts probably need to be made to prevent drug diversion in all hospital units nationwide. "Our report also suggests that strategies to prevent narcotics tampering in all health care settings are needed," he says.
The study received no external funding.
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com or MayoClinic.org/news.
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