Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures.
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.
Gutelius
Bruce
B
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Perz
Joseph F
JF
Parker
Monica M
MM
Hallack
Renee
R
Stricof
Rachel
R
Clement
Ernest J
EJ
Lin
Yulin
Y
Xia
Guo-Liang
GL
Punsalang
Amado
A
Eramo
Antonella
A
Layton
Marci
M
Balter
Sharon
S
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