Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Health care–associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus–infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients. Methods A parallel-arm lab study (n = 9) was performed in which contamination of medication vials in healthcare settings was simulated using cell culture–derived hepatitis C virus. First, surface-contaminated vials were accessed with sterile needles and syringes, and then hepatitis C virus contamination was assessed in cell culture. Second, after contaminating several medications with hepatitis C virus, viral infectivity over time was assessed. Last, surface-contaminated vial diaphragms were disinfected with 70% isopropyl alcohol to determine whether disinfection of the vial surface was sufficient to eliminate hepatitis C virus infectivity. Results Contamination of medication vials with hepatitis C virus and subsequent access with sterile needles and syringes resulted in contamination of the vial contents in sufficient quantities to initiate an infection in cell culture. Hepatitis C virus remained viable for several days in several commonly used medications. Finally, a single or 2- to 3-s wipe of the vial diaphragm with 70% isopropyl alcohol was not sufficient to eliminate hepatitis C virus infectivity. Conclusions Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.

Effectiveness of germicidal ultraviolet light to inactivate coronaviruses on personal protective equipment to reduce nosocomial transmission

“…Sample size was based on similar previous studies. 4,15,16 All data are representative of 3 independent experiments with 3 independent replicates per experiment (n = 9). All data points represent 3 independent measurements per replicate, and error bars represent standard deviation (SD).…”

Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections

“…[15,16] A study by van Vlymen demonstrated that poor hand hygiene practices inadvertently cause tiny amounts of hepatitis C virus to be placed on the outside of a medication vial, leading to further contamination and infection. [58] Improved frequency and quality of environmental cleaning of the AWE following induction and emergence of anesthesia have reduced the proportion of environmental sites reaching the 100 CFU threshold associated with high-risk stopcock transmission events. [59] This involved post-induction cleaning with a surface disinfection wipe containing both a quaternary ammonium compound and alcohol along with improved organization with designation of clean and dirty spaces, decreasing the proportion of sites reaching or exceeding 100 CFU from > 40 to 12%.…”

Viral hepatitis in patients on hemodialysis

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