Not AGAIN! Hepatitis C caused by a medical procedure

The New Hampshire Department of Health is reporting ten cases of nosocomial hepatitis C associated with a cardiac cath lab. What is unusual about this outbreak is that it is in a hospital where infection control is generally more rigorously practiced. While the exact route of transmission in this outbreak has yet to be determined, public health enemy number one has to be suspected.

http://www.fosters.com/apps/pbcs.dll/article?AID=/20120606/GJNEWS_01/120609858

In May of 2001 we did our very first hepatitis C outbreak investigation. A doc in Brooklyn reported himself after he found four of his own patients hospitalized with acute hepatitis C while on hospital rounds. He had done endoscopy on all four within the recent past. Endoscopy, more specifically colonoscopy, is recommended for screening and prevention of a big killer, colon cancer.  It is an important medical procedure, but it has risks. One of which shouldn’t be a risk, hepatitis C. When performing colonoscopy the physician reuses the equipment. That was our first suspicion and while the steps to clean the instruments didn’t follow the exact manufacturer’s instructions, we quickly ruled out the scopes as the cause. We had uncovered twelve patients over a five day period, many of who had their procedures back-to-back. There simple wasn’t time to reuse the scopes. We next zeroed in on the other invasive part of the procedure, anesthesia. We quickly discovered that all the patients had received the same drugs in about the same quantities, but what really stood out was the vials. They weren’t single use and thrown away. Meet the multi-dose vial (MDV). Intended for a single patient, these are often used for multiple patients. Why? They cost less. But it shouldn’t be a problem. As long as they are always entered with a clean needle, that is. Unfortunately, that isn’t what happens. The medical literature is littered with outbreaks traced to MDVs. We determined that a patient known to be infected with hepatitis C underwent colonoscopy. He woke up during the procedure. The anesthesiologist removed the needle and syringe that had been bathing in the patient’s blood and reinserted this into a MDV. The bottle was then used for the next fifteen or so patients, infecting twelve of them with the virus.

So, what’s the answer? For the consumer ask your doctors if they use MDVs and request that you get a fresh vial and it is thrown away when done. For us doctors, don’t use MDVs. For the FDA prohibit MDV use without appropriate engineering controls which eliminate the possibility of  accidental needle reuse. Hepatitis C is preventable.