Hepatitis outbreaks linked to poor infection control

A rise in preventable infections in physician offices and other outpatient facilities may require safety updates.

By Susan J. Landers — Posted Jan. 20, 2009

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The failure of health care personnel to follow basic infection-control procedures resulted in the exposure of thousands of patients to hepatitis B and hepatitis C viruses, says a study by researchers with the Centers for Disease Control and Prevention.

The reuse of syringes and the contamination of medications, equipment and devices were identified as common factors in 33 disease outbreaks over the past decade. All of the transmissions were preventable, the researchers concluded.

The outbreaks occurred in outpatient settings rather than hospitals. Twelve were in clinics and private physician offices, six in hemodialysis centers and 15 in long-term-care facilities. As a result, 448 people acquired HBV or HCV infections, and 60,000 people were advised to get tested, according to the study, which appears in the Jan. 6 Annals of Internal Medicine.

With many more people receiving care in outpatient settings each year, the problem is likely to become more widespread if precautions aren't taken, researchers said. Plus, hepatitis outbreaks do not bode well for overall infection-control efforts. "Investigations of viral hepatitis outbreaks in outpatient clinics, long-term-care facilities and hemodialysis centers have revealed fundamental errors that decrease confidence that basic safe-care practices are reliably maintained," they wrote.

"This report is a wake-up call," said John Ward, MD, director of the CDC's Division of Viral Hepatitis. "Thousands of patients are needlessly exposed to viral hepatitis and other preventable diseases in the very places where they should feel protected. No patient should go to their doctor for health care only to leave with a life-threatening disease."

In the largest exposure, in a Nevada endoscopy clinic in 2008, public health officials notified more than 40,000 people that they needed to be screened for HCV. Reuse of syringes was the cause, researchers said.

Reuse of syringes and contamination of anesthesia medication vials at a doctor's office in New York state in 2001 exposed more than 2,000 patients to HCV. In a separate New York incident that same year, more than 1,000 patients were placed at risk for acquiring HBV because of mishandled injection equipment and the preparation of injections in a contaminated environment, the study said.

"To protect patients, infection-control training, professional oversight, licensing, innovative engineering controls and public awareness are needed in these health care settings," said Denise Cardo, MD, director of the CDC's Division of Healthcare Quality Promotion.

CDC officials said the report shows the need for ongoing professional education and consistent state oversight in detecting and preventing the transmission of bloodborne pathogens in health care settings.

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