Results from a large-scale epidemiologic look-back investigation of improperly reprocessed endoscopy equipment.
OBJECTIVE
To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.


METHODS
Retrospective cohort study.


METHODS
Four Veterans Affairs medical centers (VAMCs).


METHODS
Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.


METHODS
Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.


RESULTS
Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.


CONCLUSIONS
Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.
Office of Public Health, Department of Veterans Affairs, Washington, DC, USA. mark.holodniy@va.gov
Mark
M
Holodniy
Gina
G
Oda
Patricia L
PL
Schirmer
Cynthia A
CA
Lucero
Yury E
YE
Khudyakov
Guoliang
G
Xia
Yulin
Y
Lin
Ronald
R
Valdiserri
William E
WE
Duncan
Victoria J
VJ
Davey
Gerald M
GM
Cross
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000635:transmission / Q000821:virology*; D057286:Electronic Health Records; D019723:Endoscopes / Q000382:microbiology*; D016021:Epidemiologic Studies; D004866:Equipment Contamination; D017743:Equipment Reuse / Q000592:standards; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015528:HIV Seroprevalence; D016174:Hepacivirus / Q000302:isolation & purification*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D014766:Viremia / Q000453:epidemiology