title: Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted during administration of intravenous anesthesia when medication vials are used for multiple patients using incorrect technique. We investigated an outbreak of acute HBV and HCV infections among patients who received anesthesia during endoscopy procedures from the same anesthesiologist (anesthesiologist 1), in 2 different gastroenterology clinics.
  
  
  METHODS
  Chart reviews, patient interviews, clinic site visits and infection control assessments, and molecular sequencing of patient isolates were performed. Patients treated by anesthesiologist 1 on specific procedure days were offered testing for blood-borne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed.
  
  
  RESULTS
  Six cases of outbreak-associated HCV infection and 6 cases of outbreak-associated HBV infection were identified in clinic 1. One outbreak-associated HCV infection was identified in clinic 2. HCV quasispecies sequences from the patients were nearly identical (96.9%-100%) to those from source patients with chronic viral hepatitis. All affected patients in both clinics received propofol from anesthesiologist 1, who inappropriately used a single-patient-use vial of propofol for multiple patients. Reuse of syringes to redose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission.
  
  
  CONCLUSIONS
  Twelve persons acquired HBV and HCV infections (6 hepatitis C, 5 hepatitis B, and 1 coinfection) in 2 separate offices as a result of receiving anesthesia from anesthesiologist 1. 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.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Gutelius
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
authors.forename: Monica M
authors.initials: MM
authors.lastname: Parker
authors.forename: Renee
authors.initials: R
authors.lastname: Hallack
authors.forename: Rachel
authors.initials: R
authors.lastname: Stricof
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Clement
authors.forename: Yulin
authors.initials: Y
authors.lastname: Lin
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Xia
authors.forename: Amado
authors.initials: A
authors.lastname: Punsalang
authors.forename: Antonella
authors.initials: A
authors.lastname: Eramo
authors.forename: Marci
authors.initials: M
authors.lastname: Layton
authors.forename: Sharon
authors.initials: S
authors.lastname: Balter
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D004196:Disease Outbreaks; D004724:Endoscopy; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006801:Humans