Tuesday, July 13, 2010

Physician Negligence

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 9 Jul 2010
Source: ModernMedicine, HealthDaily News [edited]

Improper Anesthesia Practice Causes Hepatitis Outbreak
An anesthesiologist who reused a contaminated single-use propofol
vial on multiple endoscopy patients caused an outbreak of hepatitis
infection affecting 13 patients at 2 clinics, according to a report
published in the July 2010 issue of Gastroenterology. [Propofol is a
drug used to induce or maintain anesthesia during certain surgeries,
tests, or procedures. - Mod.CP]

Bruce Gutelius, M.D., of the U.S. Centers for Disease Control and
Prevention (CDC) in Atlanta, and colleagues [reference below]
investigated outbreaks of hepatitis B virus (HBV) and hepatitis C
virus (HCV) infections among patients at the 2 clinics who had
received anesthesia from the same anesthesiologist. The investigators
reviewed medical charts, conducted patient interviews and site
visits, and performed infection control assessments. The
investigators also did molecular sequencing of available patient isolates.

At one clinic, the researchers identified 6 cases of HCV infection
and 6 cases of HBV infection, and at the other clinic, one case of
HCV infection; all the cases were associated with the outbreak. HCV
quasispecies sequences from the patients were found to be nearly
identical (96.9 to 100 percent) to those from the patients considered
to be the infection source. The investigators write that the
anesthesiologist used a single-use vial of propofol on multiple
patients, and conclude that the likely cause of the viral
transmission was the reuse of syringes to re-dose patients, which
contaminated the vials for later patients.

"Gastroenterologists are urged to review carefully the injection,
medication handling, and other infection control practices of all
staff under their supervision, including providers of anesthesia
services," the authors write.

Communicated by:

[Nosocomial transmission of hepatitis B and hepatitis C virus
infections have occurred frequently in the United States and
elsewhere as a result of medical negligence, most frequently in
association with haemodialysis. The incident described above involves
anesthesia and multiple use of a single-use vial during endoscopy. It
is presumed to refer to events 1st described in the ProMED-mail post
titled: "Hepatitis C, physician-associated cluster - USA (NY)
20070616.1965," and subsequently.

The reference for the Gastroenterology paper on which the above
report is based is the following: "Multiple Clusters of Hepatitis
Virus Infections Associated With Anesthesia for Outpatient Endoscopy
Procedures. B. Gutelius and others, Gastroenterology Volume 139,
Issue 1, Pages 163-170, July 2010
(registration, purchase required). - Mod.CP]

[see also:
Hepatitis C, physician-related cluster - Australia (04): New
Zealand 20100603.1840
Hepatitis C, physician-related cluster - Australia (03): (VI) 20100531.1807
Hepatitis C, nosocomial - China (02): (IMAR) 20100519.1657
Hepatitis C, physician-related cluster - Australia (02): (VI) 20100420.1278
Hepatitis C, physician-related cluster - Australia: (VI) 20100408.1134
Hepatitis C, dialysis-related - Spain: (TG), RFI 20100209.0447
Hepatitis C, nosocomial - China (AH), RFI 20100107.0070
Hepatitis C, transfusion related - Kazakhstan: (AA) 20091214.4243
Hepatitis C, nurse-associated - USA (02): (CO) clarification 20090708.2453
Hepatitis C, nurse-associated - USA: (CO) 20090707.2441
Hepatitis C, dialysis-related - USA: (NY) 20080917.2917
Hepatitis C, American Indians - USA: (MT) 20080325.1115
Hepatitis C, fibrinogen-transmitted - Japan: RFI 20071217.4063
Hepatitis C, physician-associated cluster - USA (NY) (04) 20071211.3988
Hepatitis C, hemodialysis unit - Spain (Barcelona) 20071209.3969
Hepatitis C, physician-associated cluster - USA (NY) (03) 20071207.3951
Hepatitis C, physician-associated cluster - USA (NY) (02) 20070628.2080
Hepatitis C, physician-associated cluster - USA (NY) 20070616.1965]

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