Endoscopic transmission of hepatitis B virus.

Abstract

SUMMARY Although transmission of hepatitis B virus (HBV) infection has long been recognised as a potential hazard of gastrointestinal endoscopy, there has been little evidence of direct patient-to-patient cross-infection after such procedures. We wish to report a case of type B viral hepatitis almost certainly acquired at endoscopy from an instrument sterilised in the conventional manner, but which had been used on the previous day on a patient with bleeding oesophageal varices who was incubating type B viral hepatitis.

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

“…For example, Birnie et al [9] (1983) report a case of patient-to-patient transmission of HBV during GI endoscopy. These authors conclude that the failure to clean, high-level disinfect, and dry the air/water channels of a gastroscope was likely the cause of HBV transmission.…”

“…These authors conclude that the failure to clean, high-level disinfect, and dry the air/water channels of a gastroscope was likely the cause of HBV transmission. While recommending that these channels be thoroughly high-level disinfected to prevent infection, Birnie et al [9] (1983) also suggest consideration of EtO gas (in lieu of high-level disinfection) to sterilize GI endoscopes potentially contaminated with HBV. (The replacement of high-level disinfection with EtO sterilization was the same measure that Hospital X implemented in 2013 to stop its CRE outbreak [25][26][27][28][29][30][31] ).…”

“…Although the risk of disease transmission during GI endoscopy is reported to be low, infections and outbreaks due to contaminated GI endoscopes, with associated patient morbidity and mortality, have been documented a number of times during the past 30 years, both prior to and since CRE's emergence [2,[4][5][6][7][8][9][10][11][12]14,33,34] . These cases include infections of bacteria, including P. aeruginosa, and viruses, namely, the hepatitis B (HBV) or C virus (HCV).…”

“…(Prior to 2001 the resistance of these transmitted strains of Enterobacteriaceae to carbapenems in the United States and globally was rare). The specific breach typically responsible for these instances of disease transmission was reported to be, as much if not more so than faulty cleaning and inadequate high-level disinfection, insufficient drying of one or more of the GI endoscope's several internal channels, particularly the exposed elevator wire channel of some models of ERCP endoscopes, using either manual reprocessing procedures or an AER [7][8][9]11,12,14] . In only a very few cases has the transmission of a bloodborne virus (i.e., HBV or HCV) been reported during GI endoscopy, with the un-sterile administration of an iv medication typically being identified as, or suspected of being, the outbreak's proximate cause or a likely contributing factor [9,10] .…”

“…Bacterial and viral outbreaks following GI endoscopy, with associated morbidity and mortality, have been reported (albeit infrequently) during the past 30 years, but the cause of virtually every one of these outbreaks was attributed to one or more infection control breaches -for example, to: (1) an endoscope reprocessing lapse, including the failure to clean the GI endoscope's instrument channel with a brush; or, the faulty reprocessing of the GI endoscope by an automated endoscope reprocessor, or AER, with a flawed internal design; (2) a damaged or improperly maintained or serviced GI endoscope; or (3) the unsterile administration of an intravenous (iv) medication [6][7][8][9][10][11][12][13][14] . Cleaning, high-level disinfection, and drying of the GI endoscope, either in strict accordance with the endoscope's labeling or, alternatively, consistent with any one of a number of recently published endoscope reprocessing guidelines, form the tridental cornerstone of infection control in the GI endoscopic setting.…”