The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60418

R. Dawn Comstock, PhD¹, Tara Vogt, PhD², Pat Scott, RN³, Jan Fox, RN³, Sue Mallonee, RN, MPH⁴, Joe Perz, MD², Beth Bell, MD, MPH⁵, Ron Moolenaar, MD⁶, and Mike Crutcher, MD, MPH⁷. (1) CDC EIS Officer stationed in the Oklahoma State Department of Health, Currently at CDC/EPO/DAPHT/State Branch/Oklahoma State Department of Health, 1000 N.E. 10th St, Room 408, Oklahoma City, OK 73117, (405) 271-3430, dawnc@health.state.ok.us, (2) CDC/NCID/DVHP, 1 West Court Square, mailstop G37, Decatur, GA 30030, (3) Oklahoma State Department of Health, 1000 N.E. 10th Street, Oklahoma City, OK 73117, (4) Injury Prevention Service, Oklahoma State Deparment of Health, 1000 NE 10th Street, Oklahoma City, OK 73112, (5) Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS G-37, Atlanta, GA 30333, (6) CDC/EPO/DAPHT/State Branch, 1600 Ckifton Rd, Mailstop D-18, Atlanta, GA 30333, (7) Communicable Disease Division, Oklahoma State Dept of Health, 1000 NE 10th St, Oklahoma City, OK 73117-1299

Background: Chronic viral hepatitis is the leading cause of chronic liver disease in the United States (U.S.); health-care–related transmission of multiple viral types is rarely reported. In August 2002, we investigated six unexplained HCV infections among patients of an Oklahoma pain management clinic. Methods: To determine the outbreak’s magnitude and etiology, we performed a seroprevalence survey, chart abstraction, and interviews among patients seen since the clinic opened in 1999. Case-patients were persons with confirmed positive HCV antibody or HBV total core antibody tests. Newly diagnosed infections were considered clinic-acquired among case-patients consecutively treated for pain. Results: Testing was performed on 750 (89.5%) of 838 clinic patients; 82 HCV and 51 HBV infections were identified. Clustering of cases occurred on 12 clinic days including one with 11 HCV-positive patients treated sequentially and one with four HBV-positive patients closely following a chronically-infected patient. Hepatitis history was reported by 8 HCV and 11 HBV case-patients; 43 HCV and 9 HBV infections were considered clinic-acquired. The source of infection for remaining cases was uncertain. A nurse anesthetist admitted routinely reusing needles/syringes to administer medication through heparin-locks of multiple patients. The incidence of clinic-acquired HCV infection was higher before (18.6%) versus after (0.0%) discontinuation of this practice in June 2002 (risk difference = 18.6, p < 0.001). Conclusions: This appears to be the first documented U.S. health-care – related outbreak of both HCV and HBV infection associated with reuse of needles/syringes. Aggressive training and monitoring of appropriate infection control practices in healthcare facilities is necessary.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Recognize the danger posed to patients by reuse of syringes/needles in anesthesia
• Understand the role unrecognized nosocomial outbreaks may play in hepatits C and B transmission in the Unites States
• List 5 responsibilities of health-care professionals for protection of patient safety which, if met, should protect patients from nosocomially acquried hepatitis infection

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.