More hepatitis C outbreaks in the news--don't let this be you!

Strict adherence to basic principles of aseptic technique is necessary to avoid transmission of hepatitis C (HCV), hepatitis B (HBV), and HIV when preparing and administering parenteral medications. Several outbreaks of HCV and HBV have been documented within ambulatory care facilities in the United States, including a recent report by the Associated Press on February 27, 2008 of a clinic in Nevada in which as many as 40,000 persons may have been exposed to HCV. A preliminary joint investigation has 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.

According to the Centers for Disease Control and Prevention (CDC), outbreaks related to unsafe injection practices indicate that some healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic technique. A survey of US healthcare workers who provide medication through injection found that 1%-3% reused the same needle and/or syringe on multiple patients. Among the deficiencies identified in recent outbreaks were a lack of oversight of personnel and failure to follow-up on reported breaches in infection control practices in ambulatory settings (1).

In Oklahoma, an outbreak of viral hepatitis associated with a pain management clinic was investigated by the Oklahoma State Department of Health (OSDH) in 2002. The practice of sequentially administering sedation medications using the same syringe and needles to all patients in an individual clinic session through a heparin lock attached to an IV cannula was determined to be the mechanism for patient-to-patient transmission of HBV and HCV. This unsafe practice was employed because the registered nurse anesthetist believed the heparin lock provided a sterile field.

Other outbreaks of HCV have occurred in New York City and Nebraska and have involved private physician's offices and hematology/oncology clinics. (2) Outbreaks such as these are unnecessary and completely preventable. Because healthcare professionals may be unknowingly placing patients at risk of exposure to bloodborne pathogens, the OSDH is encouraging all clinicians to review their procedures and adhere to the following "Do's and Don'ts" of injection practices:

Please contact the OSDH, HIV/STD Service with questions or concerns at [phone].

References:

(1) Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007 Http://www.cdc.gov/ncidod/dhgp/pdf/ isolation2007.pdf

(2) CDC. Transmission of Hepatitis B and C Viruses in Outpatient Settings--New York, Oklahoma, and Nebraska, 2000-2002. MMWR 2003; 52(38): 901-906.

(3) Infection-Control and Safe Injection Practices to Prevent Patient-to Patient Transmission of Bloodborne Pathogen. CDC. (2003). Retrieved February 29, 2008, from http://www.cdc.gov/ncidod/diseases/hepatitis/spotlights/ ambulatory.pdf

Becky Coffman, MPH, RN, CIC