title: Public health response to a large-scale endoscopy infection control lapse in a nonhospital clinic.
abstract: OBJECTIVE
  To determine whether transmission of blood-borne pathogens (BBPs) (hepatitis B virus [HBV], hepatitis C virus [HCV] and HIV) occurred as a result of endoscopy reprocessing failures identified during an inspection of a nonhospital endoscopy clinic in 2011.
  
  
  METHODS
  The present analysis was a retrospective cohort study. Registered notification letters were mailed to 6992 patients who underwent endoscopy from 2002 to 2011 at one Canadian nonhospital endoscopy clinic, informing them of the infection control lapse and offering BBP testing. Multimedia communications and a telephone line supplemented notification. A retrospective study of patients with BBPs was performed with viral genetic testing and risk factor assessment for eligible patients. Risk for infection among patients whose procedure was within seven days of a known positive patient was compared with those whose procedure was performed more than seven days after a known postive patient. The seven-day period was selected as the period most likely to present a risk for transmission based on the documented cleaning procedures at the clinic and the available literature on virus survival.
  
  
  RESULTS
  Ninety-five percent (6628 of 6992) of patients/estates were contacted and 5042 of 6728 (75%) living patients completed BBP testing. Three were newly diagnosed with HBV and 14 with HCV. Twenty-three and 48 tested positive for previously known HBV or HCV, respectively, 367 were immune to HBV due to natural infection and one was immune to HBV due to immunization. None tested positive for HIV. Sequencing did not reveal any relationships among the 46 unique case patients with viral genetic test results available. Ninety-three percent of patients reported alternative risk factors for BBP. An increased risk for infection among those who underwent a procedure within seven days of a known HBV or HCV case was not demonstrated.
  
  
  CONCLUSIONS
  Endoscopy reprocessing failures were not associated with an increased risk for BBP among individuals tested.
authors.affiliation: Ottawa Public Health;
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Willmore
authors.affiliation: Public Health and Preventive Medicine Consultant; ; University of Ottawa, Ottawa, Ontario;
authors.forename: Edward
authors.initials: E
authors.lastname: Ellis
authors.affiliation: Ottawa Public Health; ; University of Ottawa, Ottawa, Ontario;
authors.forename: Vera
authors.initials: V
authors.lastname: Etches
authors.affiliation: Ottawa Public Health;
authors.forename: Lise
authors.initials: L
authors.lastname: Labrecque
authors.affiliation: National Microbiology Laboratory, Public Health Agency of Canada; ; University of Manitoba, Winnipeg, Manitoba;
authors.forename: Carla
authors.initials: C
authors.lastname: Osiowy
authors.affiliation: National Microbiology Laboratory, Public Health Agency of Canada; ; University of Manitoba, Winnipeg, Manitoba;
authors.forename: Anton
authors.initials: A
authors.lastname: Andonov
authors.affiliation: Ottawa Public Health;
authors.forename: Cameron
authors.initials: C
authors.lastname: McDermaid
authors.affiliation: Public Health Ontario; ; Queen's University, Kingston;
authors.forename: Anna
authors.initials: A
authors.lastname: Majury
authors.affiliation: Public Health Ontario, Toronto;
authors.forename: Camille
authors.initials: C
authors.lastname: Achonu
authors.affiliation: Health Canada, Ottawa, Ontario.
authors.forename: Maurica
authors.initials: M
authors.lastname: Maher
authors.affiliation: Ottawa Public Health;
authors.forename: Brenda
authors.initials: B
authors.lastname: MacLean
authors.affiliation: Ottawa Public Health;
authors.forename: Isra
authors.initials: I
authors.lastname: Levy
keywords: Endoscopy; Infection control lapse; Public health