<i>Notes from the Field</i>: Investigation of Hepatitis C Virus Transmission Associated with Injection Therapy for Chronic Pain — California, 2015

Foster, Monique A.; Grigg, Cheri; Hagon, Jaclyn; Kim, Janice; Choi, Mary; Moorman, Anne C.; Dean, C. Ayensa

doi:10.15585/mmwr/mm6521a4

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…4 Iatrogenic HCV transmission has been reported in various outpatient settings, including hospitals and clinics for alternative medicine, cardiology, dialysis, endoscopy, insulin infusion, pain management, oncology, and prolotherapy. [5][6][7][17][18][19][20][21][22][23] The known or suspected mode of transmission includes syringe reuse, fingerstick device reuse, single-dose vial reuse, infection control lapses in medication preparation, drug diversion, and breaches in environmental cleaning and disinfection practices. 17,18 Adherence to injection safety procedures would effectively eliminate this transmission risk.…”

mentioning

confidence: 99%

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Defendorf¹,

Paul²,

Scott³

2018

J Am Osteopath Assoc

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Hepatitis C virus (HCV) infection poses significant adverse health effects. Improper use of vials, needles, syringes, intravenous bags, tubing, and connectors for injections and infusions is a current preventable cause of iatrogenic HCV transmission. Numerous cases have demonstrated the need for continued vigilance and the widespread nature of this iatrogenic infection risk across a variety of medical practice settings in the United States. Failure to implement the evidence-based Centers for Disease Control and Prevention (CDC) infection prevention guidelines exposes patients to preventable harm. The guidelines establish the requirement to notify patients in cases of suspected virus transmission, as well as to screen those patients who would not otherwise have been at risk for HCV seroconversion and other bloodborne pathogens. Legal and regulatory ramifications, including state, criminal, and tort laws, hold physicians and other health care professionals accountable to use safe injection practices. This article reviews the major health risks of HCV infection, significant effects of iatrogenic infection transmission, CDC guidelines for safe injection practices, and legal regulations and ramifications designed to promote safe injection practices.

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confidence: 99%

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Defendorf¹,

Paul²,

Scott³

2018

J Am Osteopath Assoc

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“…Four other persons who underwent procedures at the clinic on the same day were also subsequently identified to have HCV infection. Multiple other health care-associated outbreaks of HCV infection resulting from unsafe injection practices have been documented by CDC during 2008–2015 [18]. On the other hand, the largest increase in HCV observed in this study, a 127% increase from 0·52% to 1·18%, was in the Port-au-Prince region between 2010 and 2013, in the years following Haiti’s devastating 2010 earthquake.…”

Section: Discussionmentioning

confidence: 62%

Trends in hepatitis B and hepatitis C seroprevalence among blood donors – Haiti, 2005‐2014

Baptiste

Chevalier²,

Polo³

et al. 2018

ISBT Science Series

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Background and Objectives Data on the seroprevalence of viral hepatitis are limited in Haiti; consequently, the epidemiology is poorly described. This study aims to provide a descriptive analysis of hepatitis B virus (HBV) and hepatitis C virus (HCV) seroprevalence of blood donations in Haiti. Materials and Methods Using Haiti’s National Blood Safety Program and Haitian Red Cross reports from 2005 to 2014, we analysed the results of screening tests of donor serum samples to assess HBV and HCV seroprevalence among adults aged 17 to 65 years. Results A total of 198 758 donor samples were screened from 2005 to 2014, of which 0·56% were positive for antibody to hepatitis C virus (anti-HCV) and 3·80% were positive for hepatitis B surface antigen. Over the 10-year study period, anti-HCV seroprevalence among blood donors increased by 31% from 0.66% to 0.86% (95% CI: 1·01–1·70); however, this trend was not uniform over time, with a significant decrease from 0·66% in 2005 to 0·39% in 2009 (95% CI: 0·43– 0·82) and 0·43% in 2012 (95% CI: 0·50–0·90). Conversely, HBV decreased significantly by 13% from 3·95% in 2005 to 3·42% in 2014 (95% CI: 0·77–0·97), a trend that was also observed in 2012 and 2013. Conclusion The significant, uniform decrease in HBV seroprevalence in more recent years may represent the positive impact of public health interventions in preventing the transmission of blood-borne infections. More research is needed to understand why the trends in HCV transmission are non-uniform and to investigate the significant increase in more recent years.

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“…Although outbreaks of HBV 23 and HCV 13,14,24,[30][31][32] related to unsafe injection practices are infrequently recognized, unsafe injection practices have been described in a sizeable minority of health settings. In one survey, 43% of 370 physicians from 8 states reported that healthcare personnel in their workplace reentered multidose vials with the same syringe for an additional dose for the same patient; yet only 26% of physicians reporting this practice indicated that multidose vials are never used for >1 patient in their workplace.…”

Section: Discussionmentioning

confidence: 99%

“…Injection safety breaches similar to those described in this report have been associated with clusters of HBV 23 and HCV. 13,14,24,[30][31][32] The CDC has developed resources and recommendations for clinicians to ensure that safe injection practices are used in all healthcare settings. 37 Relevant recommendations include not entering medication vials with a used syringe and dedicating single-dose vials for 1 patient only.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 However, persons age 55 years and older with acute HBV or acute HCV are more likely than uninfected controls to report dialysis or injections in healthcare settings during the incubation period. 8 Patient-to-patient transmission of HBV and HCV has been reported in association with inadequate infection control during surgical, 9 dental 10 and podiatric 11 procedures, bloodglucose monitoring, 12 injections, 13,14 and hemodialysis. 15 Large outbreaks 16,17 have been reported among patients who received injections contaminated by a HCV-infected healthcare worker diverting narcotic medications for personal use.…”

mentioning

confidence: 99%

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Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

Tressler

Rosario

Kirby

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. Design: Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. Setting: Outpatient cardiology clinic. Patients: Patients undergoing MPI. Methods: Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. Results: During 2012–2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%–99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. Conclusions: This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.

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Notes from the Field: Investigation of Hepatitis C Virus Transmission Associated with Injection Therapy for Chronic Pain — California, 2015

Cited by 7 publications

References 3 publications

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Trends in hepatitis B and hepatitis C seroprevalence among blood donors – Haiti, 2005‐2014

Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

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