[Risk of transmission of hepatitis C through endoscopy of the digestive tract].
NOSOCOMIAL TRANSMISSION: Increasingly implicated in HCV infection in patients with no patent risk factors, nosocomial transmission has been demonstrated between patients hospitalized in the same ward and from health carers to patients. The risk of HCV transmission by medical instruments could only be quantified with a prospective study of examined patients. There is a theoretical risk for all endoscopic examinations whatever organ explored. Instrumental manipulations have been found as the only risk factor in blood donors. VALUE OF FORMER DISINFECTION GUIDELINES: Disinfection protocols for endoscopes have been found to eliminate 3 viruses (HCV, HBV, HIV). The endoscope-related risk could be due to minimal bleeding provoked by biopsies (risk factors independent of HCV infection) via the operator channel. THREE REPORTED CASES OF HVC INFECTION: One case of HVC infection following retrograde cholangiography and two after coloscopy have been reported. In all three cases disinfection was found to be insufficient. Recently, an official statement by the French health authorities indicates that a 20-min gluteraldehyde bath is necessary for optimal efficacy. Instruments susceptible to cause bleeding must be sterilized. The sterilization process must be tracable. The anesthesia-related risk appears to be due to use of multidose bottles or reuse of syringes. SAFE ENDOSCOPY: Disinfection procedures must be rigorously applied. One new perspective is the culture of titratable virus models. Several arguments show that well-conducted disinfection of endoscopes and medical instruments can eliminate all risk of viral transmission, including HCV.
Ouzan
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Département d'Hépatologie et de Gastroentérologie, Institut Arnault Tzanck, Saint Laurent du Var.
D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D004203:Disinfection; D019723:Endoscopes / Q000009:adverse effects / Q000821:virology*; D020699:Gastroscopes; D005773:Gastroscopy / Q000009:adverse effects*; D016174:Hepacivirus; D006526:Hepatitis C / Q000635:transmission* / Q000821:virology; D006801:Humans; D012307:Risk Factors
Risque de transmission du virus de l'hépatite C lors d'une endoscopie digestive.