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Ormsby J, Wagner T, Gupta R, Millson T, Phillips B. Safe Injection, Infusion, Medication Vial, and Point-of-Care Testing Practices in Healthcare (2025). Am J Infect Control 2025:S0196-6553(25)00330-X. [PMID: 40368281 DOI: 10.1016/j.ajic.2025.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Revised: 05/03/2025] [Accepted: 05/03/2025] [Indexed: 05/16/2025]
Abstract
PURPOSE STATEMENT This position paper provides healthcare professionals (HCP) updated guidance with corresponding evidence and rationale to support safe injection, infusion, medication vial, and point-of-care testing practices in healthcare settings. It addresses the infection risks associated with these practices but does not address other safety issues such as right dose, right site, right medication, phlebotomy, or intravenous catheter care. This document updates the Association for Professionals in Infection Control and Epidemiology (APIC) 2016 position paper.
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Affiliation(s)
- Jennifer Ormsby
- Boston Children's Hospital Infection Prevention & Control, 300 Longwood Ave, Boston, MA 02115.
| | - Tonya Wagner
- Regent Surgical Health Infection Prevention, 672 Lakeside Drive Moncks Corner, South Carolina 29461.
| | - Ria Gupta
- APIC Program Manager, Center for Research, Practice, and Innovation,1400 Crystal Drive, Suite 900, Arlington, VA 22202.
| | - Tara Millson
- Medstar Georgetown University Hospital Infection Prevention, 3800 Reservoir Rd NW, Washington, D.C. 20007.
| | - Bethany Phillips
- Advocate Health Infection Prevention, 2025 Windsor Drive Oak Brook, IL 60523.
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Henriot P, Castry M, Luong Nguyen LB, Shimakawa Y, Jean K, Temime L. Meta-analysis: risk of hepatitis C virus infection associated with hospital-based invasive procedures. Aliment Pharmacol Ther 2022; 56:558-569. [PMID: 35758763 PMCID: PMC9543323 DOI: 10.1111/apt.17106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Healthcare settings, where invasive procedures are frequently performed, may play an important role in the transmission dynamics of blood-borne pathogens when compliance with infection control precautions is suboptimal. AIMS To understand and quantify the role of hospital-based invasive procedures on hepatitis C virus (HCV) transmission. METHODS We conducted a systematic review and meta-analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures. Based on expert opinion, invasive procedures were categorised into 10 groups for which pooled measures were calculated. Finally, the relationship between pooled measures and the country-level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed by meta-regression. RESULTS We included 71 studies in the analysis. The most frequently evaluated procedures were blood transfusion (66 measures) and surgery (43 measures). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95% confidence interval: 1.14-1.88) for dental procedures to 3.22 (1.7-6.11) for transplantation. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42-5.88) than for those without a specified/recent date (2.20, 1.77-2.75). In procedure-specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery. CONCLUSIONS Various invasive procedures were significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritisation of infection control interventions, especially in high HCV prevalence settings.
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Affiliation(s)
- Paul Henriot
- MESuRS LaboratoryConservatoire National des Arts et MétiersParisFrance
- PACRI UnitConservatoire National des Arts et Métiers/Institut PasteurParisFrance
| | | | | | - Yusuke Shimakawa
- PACRI UnitConservatoire National des Arts et Métiers/Institut PasteurParisFrance
- Unité d'Epidémiologie des Maladies ÉmergentesInstitut PasteurParisFrance
| | - Kévin Jean
- MESuRS LaboratoryConservatoire National des Arts et MétiersParisFrance
- PACRI UnitConservatoire National des Arts et Métiers/Institut PasteurParisFrance
| | - Laura Temime
- MESuRS LaboratoryConservatoire National des Arts et MétiersParisFrance
- PACRI UnitConservatoire National des Arts et Métiers/Institut PasteurParisFrance
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An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario. ACTA ACUST UNITED AC 2021; 47:224-231. [PMID: 34035670 DOI: 10.14745/ccdr.v47i04a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). Objective To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. Methods Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case's procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. Outcome A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. Conclusion Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.
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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Engda T. The contribution of medical educational system of the College of Medicine, and Health Sciences of the University of Gondar in Ethiopia on the knowledge, attitudes, and practices of graduate students of Health Sciences in relation to the prevention and control of nosocomial infections during the academic year of 2018. BMC MEDICAL EDUCATION 2020; 20:378. [PMID: 33092581 PMCID: PMC7579876 DOI: 10.1186/s12909-020-02271-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nosocomial infection, also called a hospital-acquired infection, is an infection acquired during admitting patients in health care facilities. Nosocomial infection can be prevented and controlled by giving training to those responsible. This study aimed to assess the contribution of the medical education system on the knowledge, attitudes, and practices of the graduate students of health sciences about the prevention and control of nosocomial infection in the College of Medicine and Health Sciences at the University of Gondar in the Academic Year of 2018. METHOD An institution-based cross-sectional study was conducted among all graduate health science students posted in the different departments at the University of Gondar in the College of Medicine and Health Sciences from February to June 2018. A total of 422 study participants were included. Data were analyzed using SPSS version 20. RESULTS Out of a total of 422 respondents, only 40% have taken training for infection prevention; out of which 39% had taken the training for a year ago. Moreover, only 35.5% have good knowledge of nosocomial infections as a result of the training; and only 32.5% have good understanding of the practical training given on prevention and control. Only 36% have good attitude towards its prevention and control. CONCLUSION The result shows that only a few of the respondents have taken the infection prevention training. Yet, a smaller proportion of them had good knowledge, attitude, and practice on nosocomial infections. Hence, the Medical Education System should give more attention to the training of the nosocomial infection control by developing different strategies to prepare the students on these issues before they start their clinical attachment.
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Affiliation(s)
- Tigist Engda
- Department of Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia.
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Alroy-Preis S, Daly ER, Adamski C, Dionne-Odom J, Talbot EA, Gao F, Cavallo SJ, Hansen K, Mahoney JC, Metcalf E, Loring C, Bean C, Drobeniuc J, Xia GL, Kamili S, Montero JT. Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician. Clin Infect Dis 2019; 67:845-853. [PMID: 29767683 DOI: 10.1093/cid/ciy193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/27/2018] [Indexed: 12/16/2022] Open
Abstract
Background In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. Methods NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. Results HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee's status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. Conclusions This is the largest laboratory-confirmed drug diversion-associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided.
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Affiliation(s)
- Sharon Alroy-Preis
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Elizabeth R Daly
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Christine Adamski
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Jodie Dionne-Odom
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Elizabeth A Talbot
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Fengxiang Gao
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Steffany J Cavallo
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Katrina Hansen
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Jennifer C Mahoney
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Erin Metcalf
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Carol Loring
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Christine Bean
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Guo-Liang Xia
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - José T Montero
- New Hampshire Department of Health and Human Services, Division of Public Health Services, Concord
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Feemster K, Localio R, Grundmeier R, Metlay JP, Coffin SE. Incidence of Healthcare-Associated Influenza-Like Illness After a Primary Care Encounter Among Young Children. J Pediatric Infect Dis Soc 2019; 8:191-196. [PMID: 29579251 DOI: 10.1093/jpids/piy023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite potential respiratory virus transmission in pediatric clinics, little is known about the risk of healthcare-associated viral infections attributable to outpatient encounters. We evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI). METHODS Using electronic health record data, we conducted a retrospective cohort study of all children aged <6 years who presented to a provider in a 29-clinic pediatric primary care network for a non-ILI-related encounter over 2 respiratory virus seasons (September 1, 2012, to April 30, 2014). We defined a risk period for potential healthcare-associated (HA) ILI of 1 to 8 days after a non-ILI clinic visit and identified all cases of ILI to compare the incidences of ILI visits 1 to 8 days after a non-ILI encounter and those of visits >8 days after a non-ILI encounter. RESULTS Among 149987 children <6 years of age (mean age, 2.5 years) with ≥1 non-ILI visit during the study period, 531928 total encounters and 13951 (2.9%) ILI encounters were identified; 1941 (13.9%) occurred within the HA-ILI risk window. The incidence rate ratios (IRRs) for ILI 1 to 8 days after compared with ILI >8 days after a non-ILI visit during season 1 were 1.36 (95% confidence interval, 1.22-1.52) among children ≥2 years of age and 1.01 (95% confidence interval, 0.93-1.09) among children <2 years of age. Estimates remained consistent during season 2 and with a risk window of 3, 4, or 9 days. CONCLUSIONS Pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged <2 years. These findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in HA ILI in young children.
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Affiliation(s)
- Kristen Feemster
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert Grundmeier
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Joshua P Metlay
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Susan E Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Abstract
BACKGROUND The Socio-Technical Probabilistic Risk Assessment, a proactive risk assessment tool imported from high-risk industries, was used to identify risks for surgical site infections (SSIs) associated with the ambulatory surgery center setting and to guide improvement efforts. OBJECTIVES This study had 2 primary objectives: (1) to identify the critical risk factors associated with SSIs resulting from procedures performed at ambulatory surgery centers and (2) to design an intervention to mitigate the probability of SSI for the highest risk factors identified. METHODS Inputs included quantitative and qualitative data sources from the evidence-based literature and from health care providers. The Socio-Technical Probabilistic Risk Assessment ranked the failure points (events) on the basis of their contribution to an SSI. The event, entitled "Failure to protect the patient effectively," which included several failure points, was the most critical unique event with the highest contribution to SSI risk. RESULTS A total of 51.87% of SSIs in this setting were caused by this failure. Consequently, we proposed an intervention aimed at all 5 major components of this failure. CONCLUSIONS The intervention targets improvements in skin preparation; proper administration of antibiotics; staff training in infection control principles, including practices for the prevention of glove punctures; and procedures to ensure the removal of watches, jewelry, and artificial nails.
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Kossover-Smith RA, Coutts K, Hatfield KM, Cochran R, Akselrod H, Schaefer MK, Perz JF, Bruss K. One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety. Am J Infect Control 2017. [PMID: 28625701 DOI: 10.1016/j.ajic.2017.04.292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To inform development, targeting, and penetration of materials from a national injection safety campaign, an evaluation was conducted to assess provider knowledge, attitudes, and practices related to unsafe injection practices. METHODS A panel of physicians (n = 370) and nurses (n = 320) were recruited from 8 states to complete an online survey. Questions, using 5-point Likert and Spector scales, addressed acceptability and frequency of unsafe practices (eg, reuse of a syringe on >1 patient). Results were stratified to identify differences among physician specialties and nurse practice locations. RESULTS Unsafe injection practices were reported by both physicians and nurses across all surveyed physician specialties and nurse practice locations. Twelve percent (12.4%) of physicians and 3% of nurses indicated reuse of syringes for >1 patient occurs in their workplace; nearly 5% of physicians indicated this practice usually or always occurs. A higher proportion of oncologists reported unsafe practices occurring in their workplace. CONCLUSIONS There is a dangerous minority of providers violating basic standards of care; practice patterns may vary by provider group and specialty. More research is needed to understand how best to identify providers placing patients at risk of infection and modify their behaviors.
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10
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Tai E, Guy GP, Dunbar A, Richardson LC. Cost of Cancer-Related Neutropenia or Fever Hospitalizations, United States, 2012. J Oncol Pract 2017; 13:e552-e561. [PMID: 28437150 DOI: 10.1200/jop.2016.019588] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Neutropenia and subsequent infections are life-threatening treatment-related toxicities of chemotherapy. Among patients with cancer, hospitalizations related to neutropenic complications result in substantial medical costs, morbidity, and mortality. Previous estimates for the cost of cancer-related neutropenia hospitalizations are based on older and limited data. This study provides nationally representative estimates of the cost of cancer-related neutropenia hospitalizations. METHODS We examined data from the 2012 National Inpatient Sample and Kids' Inpatient Database. Hospitalizations for cancer-related neutropenia were defined as those with a primary or secondary diagnosis of cancer and a diagnosis of neutropenia or a fever of unknown origin. We examined characteristics of cancer-related neutropenia hospitalizations among children (age < 18 years) and adults (age ≥ 18 years). Adjusted predicted margins were used to estimate length of stay and cost per stay. RESULTS There were 91,560 and 16,859 cancer-related neutropenia hospitalizations among adults and children, respectively. Total cost of cancer-related neutropenia hospitalizations was $2.3 billion for adults and $439 million for children. Cancer-related neutropenia hospitalizations accounted for 5.2% of all cancer-related hospitalizations and 8.3% of all cancer-related hospitalization costs. For adults, the mean length of stay for cancer-related neutropenia hospitalizations was 9.6 days, with a mean hospital cost of $24,770 per stay. For children, the mean length of stay for cancer-related neutropenia hospitalizations was 8.5 days, with a mean hospital cost of $26,000 per stay. CONCLUSION We found the costs of cancer-related neutropenia hospitalizations to be substantially high. Efforts to prevent and minimize neutropenia-related complications among patients with cancer may decrease hospitalizations and associated costs.
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Affiliation(s)
- Eric Tai
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Angela Dunbar
- Centers for Disease Control and Prevention, Atlanta, GA
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Yablon BR, Dantes R, Tsai V, Lim R, Moulton-Meissner H, Arduino M, Jensen B, Patel MT, Vernon MO, Grant-Greene Y, Christiansen D, Conover C, Kallen A, Guh AY. Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013. Infect Control Hosp Epidemiol 2017; 38:314-319. [PMID: 27919308 PMCID: PMC6489440 DOI: 10.1017/ice.2016.265] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.
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Affiliation(s)
- Brian R. Yablon
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
| | - Raymund Dantes
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | - Victoria Tsai
- Illinois Department of Public Health, Chicago, Illinois
- Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Altanta, Georgia
| | - Rachel Lim
- West Suburban Medical Center, Oak Park, Illinois
| | | | - Matthew Arduino
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | - Bette Jensen
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | | | | | - Yoran Grant-Greene
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
- Illinois Department of Public Health, Chicago, Illinois
| | | | - Craig Conover
- Illinois Department of Public Health, Chicago, Illinois
| | | | - Alice Y. Guh
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
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Abstract
Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices. Infect Control Hosp Epidemiol 2017;38:614-616.
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Dolan SA, Arias KM, Felizardo G, Barnes S, Kraska S, Patrick M, Bumsted A. APIC position paper: Safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2016; 44:750-7. [PMID: 27184207 DOI: 10.1016/j.ajic.2016.02.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/21/2023]
Abstract
The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures continues to occur because of the use of improper injection, infusion, medication vial, and point-of-care testing practices by health care personnel. These unsafe practices occur in various clinical settings and result in unacceptable and devastating events for patients. This document updates the Association for Professionals in Infection Control and Epidemiology 2010 position paper on safe injection, infusion, and medication vial practices in health care.
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Garmaeva TT, Kulikov SM. [Blood component donors and recipients as linked study objects in epidemiological population-based surveys]. TERAPEVT ARKH 2016; 87:134-138. [PMID: 26821431 DOI: 10.17116/terarkh20158711134-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A population of hematological cancer patients as recipients of many blood components and that of donors of blood components and bone marrow are related to the common event of contamination with viruses of blood-borne infections; which occurs and is detectable during long-term treatment and follow-up. They share interaction traits and diverse communication mechanisms, which call for complex interrelated trials in both groups with a mandatory epidemiological evidenced-based investigation of all cases of posttransfusion hepatitis B and/or C. The identity of infection with hepatitis B and C viruses, human immunodeficiency virus, and their association should be simultaneously studied in the populations of both donors and recipients of blood components and bone marrow.
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Affiliation(s)
- T Ts Garmaeva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia; Peoples' Friendship University of Russia, Moscow, Russia
| | - S M Kulikov
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
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OYong K, Coelho L, Bancroft E, Terashita D. Health Care-Associated Infection Outbreak Investigations in Outpatient Settings, Los Angeles County, California, USA, 2000-2012. Emerg Infect Dis 2016. [PMID: 26196293 PMCID: PMC4517738 DOI: 10.3201/eid2108.141251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Most investigations identified a control breach as the source of infections. Health care services are increasingly delivered in outpatient settings. However, infection control oversight in outpatient settings to ensure patient safety has not improved and literature quantifying reported health care–associated infection outbreaks in outpatient settings is scarce. The objective of this analysis was to characterize investigations of suspected and confirmed outbreaks in outpatient settings in Los Angeles County, California, USA, reported during 2000–2012, by using internal logs; publications; records; and correspondence of outbreak investigations by characteristics of the setting, number, and type of infection control breaches found during investigations, outcomes of cases, and public health responses. Twenty-eight investigations met the inclusion criteria. Investigations occurred frequently, in diverse settings, and required substantial public health resources. Most outpatient settings investigated had >1 infection control breach. Lapses in infection control were suspected to be the outbreak source for 16 of the reviewed investigations.
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See I, Nguyen DB, Chatterjee S, Shwe T, Scott M, Ibrahim S, Moulton-Meissner H, McNulty S, Noble-Wang J, Price C, Schramm K, Bixler D, Guh AY. Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012. Infect Control Hosp Epidemiol 2015; 35:300-6. [PMID: 24521597 DOI: 10.1086/675282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. DESIGN Epidemiologic investigation of the outbreak with a case-control study. METHODS A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. RESULTS Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. CONCLUSION Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.
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Affiliation(s)
- Isaac See
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center. Am J Infect Control 2014; 42:731-4. [PMID: 24969124 DOI: 10.1016/j.ajic.2014.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center. METHODS Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing. RESULTS Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%). CONCLUSIONS Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.
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Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014; 104:482-7. [PMID: 24432918 PMCID: PMC3953761 DOI: 10.2105/ajph.2013.301601] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Because only a fraction of patients with acute viral hepatitis A, B, and C are reported through national surveillance to the Centers for Disease Control and Prevention, we estimated the true numbers. METHODS We applied a simple probabilistic model to estimate the fraction of patients with acute hepatitis A, hepatitis B, and hepatitis C who would have been symptomatic, would have sought health care tests, and would have been reported to health officials in 2011. RESULTS For hepatitis A, the frequencies of symptoms (85%), care seeking (88%), and reporting (69%) yielded an estimate of 2730 infections (2.0 infections per reported case). For hepatitis B, the frequencies of symptoms (39%), care seeking (88%), and reporting (45%) indicated 18 730 infections (6.5 infections per reported case). For hepatitis C, the frequency of symptoms among injection drug users (13%) and those infected otherwise (48%), proportion seeking care (88%), and percentage reported (53%) indicated 17 100 infections (12.3 infections per reported case). CONCLUSIONS These adjustment factors will allow state and local health authorities to estimate acute hepatitis infections locally and plan prevention activities accordingly.
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Affiliation(s)
- R Monina Klevens
- At the time of the study, all authors were with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STDs and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Perez F, Deshpande A, Kundrapu S, Hujer AM, Bonomo RA, Donskey CJ. Pseudo-outbreak of Klebsiella oxytoca spontaneous bacterial peritonitis attributed to contamination of multidose vials of culture medium supplement. Infect Control Hosp Epidemiol 2013; 35:139-43. [PMID: 24442075 DOI: 10.1086/674857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the source of a cluster of Klebsiella oxytoca isolates cultured from peritoneal fluid of 3 patients with cirrhosis on a single day. DESIGN Outbreak investigation and before-after study. SETTING A Veterans Affairs medical center. METHODS Epidemiologic investigation, analysis of antimicrobial susceptibility testing results and molecular typing of K. oxytoca isolates with repetitive sequence-based polymerase chain reaction (rep-PCR), review of microbiology laboratory procedures for processing peritoneal fluid cultures, and comparison of peritoneal fluid contamination rates 18 months before and after modification of laboratory procedures for culturing peritoneal fluid. RESULTS Each of the peritoneal fluid samples that grew K. oxytoca was inoculated into blood culture bottles by different clinicians at different hospital locations. None of the patients had clinical findings suggestive of peritonitis or elevated polymorphonuclear cell counts in peritoneal fluid (range, 3-25 cells/μL). Molecular typing with rep-PCR demonstrated that the K. oxytoca isolates were genetically related (greater than 95% similarity). Laboratory procedures included the routine addition of a culture medium supplement of yeast extract and dextrose from a multidose vial into blood culture bottles with peritoneal fluid. After discontinuing use of the culture medium supplement, there was a marked reduction in the number of peritoneal fluid cultures deemed as contaminants (14.3% vs 0.9%; [Formula: see text]). CONCLUSION A pseudo-outbreak of K. oxytoca peritonitis and high rates of contamination of peritoneal fluid were attributable to contamination of a multidose culture medium supplement. This article highlights the importance of discouraging the use of multidose vials in all clinical settings.
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Affiliation(s)
- Federico Perez
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Matovina-Brko G, Ruzic M, Fabri M, Popovic L, Kolarov-Bjelobrk I, Trifunovic J, Petkovic D. Treatment of acute hepatitis C in breast cancer patient: a case report. J Chemother 2013; 26:180-3. [DOI: 10.1179/1973947813y.0000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Paintsil E, Binka M, Patel A, Lindenbach BD, Heimer R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis 2013; 209:1205-11. [PMID: 24273176 DOI: 10.1093/infdis/jit648] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Healthcare workers may come into contact with fomites that contain infectious hepatitis C virus (HCV) during preparation of plasma or following placement or removal of venous lines. Similarly, injection drugs users may come into contact with fomites. Hypothesizing that prolonged viability of HCV in fomites may contribute significantly to incidence, we determined the longevity of virus infectivity and the effectiveness of antiseptics. METHODS We determined the volume of drops misplaced during transfer of serum or plasma. Aliquots equivalent to the maximum drop volume of plasma spiked with the 2a HCV reporter virus were loaded into 24-well plates. Plates were stored uncovered at 3 temperatures: 4°C, 22°C, and 37°C for up to 6 weeks before viral infectivity was determined in a microculture assay. RESULTS The mean volume of an accidental drop was 29 µL (min-max of 20-33 µL). At storage temperatures 4°C and 22°C, we recovered viable HCV from the low-titer spots for up to 6 weeks of storage. The rank order of HCV virucidal activity of commonly used antiseptics was bleach (1:10) > cavicide (1:10) > ethanol (70%). CONCLUSIONS The hypothesis of potential transmission from fomites was supported by the experimental results. The anti-HCV activity of commercial antiseptics varied.
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Affiliation(s)
- Elijah Paintsil
- Departments of Pediatrics and Pharmacology, Yale School of Medicine
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Minimizing the risk of non-vertical, non-sexual HIV infection in children--beyond mother to child transmission. J Int AIDS Soc 2012. [PMID: 23199798 PMCID: PMC3500456 DOI: 10.7448/ias.15.2.17377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
After witnessing an episode of poor injection safety in large numbers of children in a rural under-resourced hospital in Uganda, we briefly review our own experience and that of others in investigating HIV infection in children considered unlikely to be through commonly identified routes such as vertical transmission, sexual abuse or blood transfusion. In the majority of cases, parents are HIV uninfected. The cumulative experience suggests that the problem is real, but with relatively low frequency. Vertical transmission is the major route for HIV to children. However, factors such as poor injection safety, undocumented surrogate breast feeding, an HIV-infected adult feeding premasticated food to a weaning toddler, poor hygienic practice in the home and using unsterilised equipment for minor surgical or traditional procedures are of cumulative concern.
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Doerrbecker J, Behrendt P, Mateu-Gelabert P, Ciesek S, Riebesehl N, Wilhelm C, Steinmann J, Pietschmann T, Steinmann E. Transmission of hepatitis C virus among people who inject drugs: viral stability and association with drug preparation equipment. J Infect Dis 2012; 207:281-7. [PMID: 23129759 DOI: 10.1093/infdis/jis677] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) transmission among people who inject drugs remains a challenging public health problem. We investigated the risk of HCV transmission by analyzing the direct association of HCV with filters, water to dilute drugs, and water containers. METHODS Experiments were designed to replicate practices by people who inject drugs and include routinely used injection equipment. HCV stability in water was assessed by inoculation of bottled water with HCV. Viral association with containers was investigated by filling the containers with water, inoculating the water with HCV, emptying the water, and refilling the container with fresh water. Transmission risk associated with drug preparation filters was determined after drawing virus through a filter and incubating the filter to release infectious particles. RESULTS HCV can survive for up to 3 weeks in bottled water. Water containers present a risk for HCV transmission, as infectious virions remained associated with water containers after washing. Physical properties of the water containers determined the degree of HCV contamination after containers were refilled with water. HCV was also associated with filter material, in which around 10% of the viral inoculum was detectable. CONCLUSIONS This study demonstrates the potential risk of HCV transmission among injection drug users who share water, filters, and water containers and will help to define public health interventions to reduce HCV transmission.
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Affiliation(s)
- Juliane Doerrbecker
- Institute of Experimental Virology, Twincore, Centre for Experimental and Clinical Infection Research, Medical School Hannover and Helmholtz Centre for Infection Research, Hannover, Germany
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Patient notification for bloodborne pathogen testing due to unsafe injection practices in the US health care settings, 2001-2011. Med Care 2012; 50:785-91. [PMID: 22525612 DOI: 10.1097/mlr.0b013e31825517d4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syringe reuse and other unsafe injection practices can expose patients to bloodborne pathogens (eg, hepatitis B and C viruses and human immunodeficiency virus). Evidence of such infection control lapses has resulted in patient notifications, but the scope and magnitude of these events have not been well characterized. OBJECTIVES To summarize patient notification events resulting from unsafe injection practices in the US health care settings. METHODS We examined records of events that involved communications to groups of patients, conducted during 2001-2011, advising bloodborne pathogen testing stemming from potential exposures to unsafe injection practices. RESULTS We identified 35 patient notification events related to unsafe injection practices in at least 17 states, resulting in an estimated total of 130,198 patients notified. Among the identified notification events, 83% involved outpatient settings and 74% occurred since 2007, including the 4 largest events (>5000 patients per event). The primary breach identified (≥16 events; 44%) was syringe reuse to access shared medications (eg, single-dose or multidose vials). Twenty-two (63%) notifications stemmed from the identification of viral hepatitis transmission, whereas 13 (37%) were prompted by the discovery of unsafe injection practices, absent evidence of bloodborne pathogen transmission. CONCLUSIONS Unsafe injection practices represent a form of medical error that have manifested as large-scale adverse events, affecting thousands of patients in a wide variety of health care settings. Our findings suggest that increased oversight and attention to basic infection control are needed to maintain patient safety, along with research to identify best practices for triggering and managing patient notifications.
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Steinmann E, Gravemann U, Friesland M, Doerrbecker J, Müller TH, Pietschmann T, Seltsam A. Two pathogen reduction technologies--methylene blue plus light and shortwave ultraviolet light--effectively inactivate hepatitis C virus in blood products. Transfusion 2012; 53:1010-8. [PMID: 22905868 DOI: 10.1111/j.1537-2995.2012.03858.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Contamination of blood products with hepatitis C virus (HCV) can cause infections resulting in acute and chronic liver diseases. Pathogen reduction methods such as photodynamic treatment with methylene blue (MB) plus visible light as well as irradiation with shortwave ultraviolet (UVC) light were developed to inactivate viruses and other pathogens in plasma and platelet concentrates (PCs), respectively. So far, their inactivation capacities for HCV have only been tested in inactivation studies using model viruses for HCV. Recently, a HCV infection system for the propagation of infectious HCV in cell culture was developed. STUDY DESIGN AND METHODS Inactivation studies were performed with cell culture-derived HCV and bovine viral diarrhea virus (BVDV), a model for HCV. Plasma units or PCs were spiked with high titers of cell culture-grown viruses. After treatment of the blood units with MB plus light (Theraflex MB-Plasma system, MacoPharma) or UVC (Theraflex UV-Platelets system, MacoPharma), residual viral infectivity was assessed using sensitive cell culture systems. RESULTS HCV was sensitive to inactivation by both pathogen reduction procedures. HCV in plasma was efficiently inactivated by MB plus light below the detection limit already by 1/12 of the full light dose. HCV in PCs was inactivated by UVC irradiation with a reduction factor of more than 5 log. BVDV was less sensitive to the two pathogen reduction methods. CONCLUSIONS Functional assays with human HCV offer an efficient tool to directly assess the inactivation capacity of pathogen reduction procedures. Pathogen reduction technologies such as MB plus light treatment and UVC irradiation have the potential to significantly reduce transfusion-transmitted HCV infections.
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Affiliation(s)
- Eike Steinmann
- Division of Experimental Virology, Twincore, Centre for Experimental and Clinical Infection Research, a joint venture between the Medical School Hannover and the Helmholtz Centre for Infection Research, Hannover, Germany
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26
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Shuman EK, Chenoweth CE. Reuse of medical devices: implications for infection control. Infect Dis Clin North Am 2012; 26:165-72. [PMID: 22284382 DOI: 10.1016/j.idc.2011.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reuse of both single-use and multiuse medical devices is a common practice and can result in transmission of infection when appropriate sterilization or reprocessing does not occur. Reuse of single-use devices can be problematic because there are no clear standards for reprocessing, although data regarding adverse outcomes are limited. Single-use devices are commonly reused, appropriately or inappropriately, in resource-limited settings because of cost constraints. Reuse of medical devices raises important legal and ethical questions.
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Affiliation(s)
- Emily K Shuman
- Division of Infectious Diseases, University of Michigan, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378, USA
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27
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Injection practices of healthcare professionals in a Tertiary Care Hospital. J Infect Public Health 2012; 5:177-81. [PMID: 22541265 DOI: 10.1016/j.jiph.2012.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Unsafe injection practices are prevalent worldwide and may result in spread of infection. Thus the present study was planned to observe the injection practices of healthcare professionals (HCP), including aseptic precautions and disposal of used syringes/needle. MATERIALS AND METHODS Injection practices were observed in the outpatients and inpatients departments. Questionnaire was designed, tested and administered for this purpose. RESULTS 130 patients receiving injections were observed. Overall injection practices of the HCP were satisfactory. However, unsafe practices with respect to not washing hands (95.4%), not wearing/changing gloves (61.6%), recapping of needles (12.2%), wiping of needle with swab (15.4%) and breaking of ampoule with solid object (44.4%) were observed. CONCLUSION The problem of unsafe injections can be successfully addressed by organizing continuing medical education/symposium/workshops for improving the knowledge, attitude and practices of the HCP. Periodic monitoring and such interventions may also further improve safe injection practices.
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Radcliffe R, Meites E, Briscoe J, Gupta R, Fosheim G, McAllister SK, Jensen B, Noble-Wang J, del Rosario M, Hageman J, Patel PR. Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic. Am J Infect Control 2012; 40:144-9. [PMID: 21764479 DOI: 10.1016/j.ajic.2011.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 03/04/2011] [Accepted: 03/04/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic. METHODS We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis. RESULTS Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis. CONCLUSION Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission.
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Affiliation(s)
- Rachel Radcliffe
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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29
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Doerrbecker J, Friesland M, Ciesek S, Erichsen TJ, Mateu-Gelabert P, Steinmann J, Steinmann J, Pietschmann T, Steinmann E. Inactivation and survival of hepatitis C virus on inanimate surfaces. J Infect Dis 2011; 204:1830-8. [PMID: 22013220 DOI: 10.1093/infdis/jir535] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) cross-contamination from inanimate surfaces or objects has been implicated in transmission of HCV in health-care settings and among injection drug users. We established HCV-based carrier and drug transmission assays that simulate practical conditions to study inactivation and survival of HCV on inanimate surfaces. METHODS Studies were performed with authentic cell culture derived viruses. HCV was dried on steel discs and biocides were tested for their virucidal efficacy against HCV. Infectivity was determined by a limiting dilution assay. HCV stability was analyzed in a carrier assay for several days or in a drug transmission assay using a spoon as cooker. RESULTS HCV can be dried and recovered efficiently in the carrier assay. The most effective alcohol to inactivate the virus was 1-propanol, and commercially available disinfectants reduced infectivity of HCV to undetectable levels. Viral infectivity on inanimate surfaces was detectable in the presence of serum for up to 5 days, and temperatures of about 65-70°C were required to eliminate infectivity in the drug transmission assay. CONCLUSIONS These findings are important for assessment of HCV transmission risks and should facilitate the definition of stringent public health interventions to prevent HCV infections.
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Affiliation(s)
- Juliane Doerrbecker
- Division of Experimental Virology, Twincore, Centre for Experimental and Clinical, Infection Research, a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Germany
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Greeley RD, Semple S, Thompson ND, High P, Rudowski E, Handschur E, Xia GL, Ganova-Raeva L, Crawford J, Robertson C, Tan C, Montana B. Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009. Am J Infect Control 2011; 39:663-670. [PMID: 21658812 DOI: 10.1016/j.ajic.2010.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/19/2010] [Accepted: 11/29/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND Transmission of bloodborne pathogens due to breaches in infection control is becoming increasingly recognized as greater emphasis is placed on reducing health care-associated infections. Two women, aged 60 and 77 years, were diagnosed with acute hepatitis B virus (HBV) infection; both received chemotherapy at the same physician's office. Due to suspicion of health care-associated HBV transmission, a multidisciplinary team initiated an investigation of the hematology-oncology office practice. METHODS We performed an onsite inspection and environmental assessment, staff interviews, records review, and observation of staff practices. Patients who visited the office practice between January 1, 2006 and March 3, 2009 were advised to seek testing for bloodborne pathogens. Patients and medical providers were interviewed. Specimens from HBV-infected patients were sent to the Centers for Disease Control and Prevention for HBV DNA testing and phylogenic analysis. RESULTS Multiple breaches in infection control were identified, including deficient policies and procedures, improper hand hygiene, medication preparation in a blood processing area, common-use saline bags, and reuse of single-dose vials. The office practice was closed, and the physician's license was suspended. Out of 2,700 patients notified, test results were available for 1,394 (51.6%). Twenty-nine outbreak-associated HBV cases were identified. Specimens from 11 case-patients demonstrated 99.9%-100% nucleotide identity on phylogenetic analysis. CONCLUSION Systematic breaches in infection control led to ongoing transmission of HBV infection among patients undergoing invasive procedures at the office practice. This investigation underscores the need for improved regulatory oversight of outpatient health care settings, improved infection control and injection safety education for health care providers, and the development of mechanisms for ongoing communication and cooperation among public health agencies.
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Smedley EJ, Stelzer-Braid S, Ressler KA, Melling P, Bowden S, McCaw R, White PA, Vickers CR, Rawlinson WD, Ferson MJ. Transmission of hepatitis C virus to recipients of parenteral vitamin therapy in a primary care facility. J Clin Virol 2011; 51:105-9. [PMID: 21507711 DOI: 10.1016/j.jcv.2011.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 03/17/2011] [Accepted: 03/21/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The Australian prevalence of hepatitis C virus (HCV) is approximately 1%, with the majority of cases acquired through injecting drug use. However, occasionally HCV infection occurs in healthcare settings. Three new HCV infections were identified amongst patients attending a general practice in Sydney, Australia, specialising in parenteral vitamin therapy. STUDY DESIGN An investigation was conducted to identify the source of infection and mechanism of transmission. Molecular analysis was conducted by sequencing the HCV NS5A, Core and NS5B regions. RESULTS Two sources were identified using molecular epidemiology - a genotype 3a case was the source for a case acquired in late 2004 and a genotype 1b case the source for one case acquired in late 2006 and another in early 2007. The common risk factor was parenteral vitamin C therapy. CONCLUSIONS Inadequate infection control was apparent and likely to have resulted in blood contamination of the healthcare workers, their equipment, the clinic environment and parenteral medications. Molecular and clinical epidemiology clearly identified parenteral transmission of HCV, highlighting the risks of blood contamination of parenteral equipment and use of multi-dose flasks on more than one patient.
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Affiliation(s)
- E J Smedley
- Public Health Unit, South Eastern Sydney Illawarra Area Health Service, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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Pugliese G, Gosnell C, Bartley JM, Robinson S. Injection practices among clinicians in United States health care settings. Am J Infect Control 2010; 38:789-98. [PMID: 21093696 DOI: 10.1016/j.ajic.2010.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 09/27/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Improper use of syringes, needles, and medication vials has resulted in patient-to-patient transmission of bloodborne pathogens, including hepatitis C virus. This study examined the injection practices of health care providers to identify trends and target opportunities for education on safe practices. METHODS An on-line survey was conducted in May and June 2010 of clinicians in US health care settings that prepare and/or administer parenteral medications. RESULTS The majority of the 5446 eligible respondents reported injection practices consistent with current recommendations. However, the following unsafe practices were identified: 6.0% "sometimes or always" use single-dose/single-use vials for more than 1 patient; 0.9% "sometimes or always" reuse a syringe but change the needle for use on a second patient; 15.1% reuse a syringe to enter a multidose vial and then 6.5% save that vial for use on another patient (1.1% overall). CONCLUSION Unsafe injection practices represent an ongoing threat to patient safety. Ensuring safe injection practices in all health care settings will require a multifaceted approach that focuses on surveillance, oversight, enforcement, and continuing education.
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Letter in response to K. Jansky. Am J Infect Control 2010. [DOI: 10.1016/j.ajic.2010.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gutelius B, Perz JF, Parker MM, Hallack R, Stricof R, Clement EJ, Lin Y, Xia GL, Punsalang A, Eramo A, Layton M, Balter S. Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures. Gastroenterology 2010; 139:163-70. [PMID: 20353790 DOI: 10.1053/j.gastro.2010.03.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 02/08/2010] [Accepted: 05/22/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS 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.
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Affiliation(s)
- Bruce Gutelius
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fazili J, Mallonee S, Tierney WM, Bader TF, Sachdev AK, Bird PC, Schmidt RD, Mesiya SA, Lackey CL. Outcome of a hepatitis C outbreak among patients in a pain management clinic. Dig Dis Sci 2010; 55:1738-43. [PMID: 20411419 DOI: 10.1007/s10620-010-1228-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 03/25/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS The aims of this study are to evaluate the natural history and response to therapy of patients following a hepatitis C outbreak in a pain management clinic. METHODS A retrospective cohort study was conducted on patients who acquired hepatitis C virus (HCV) at a pain management clinic. Medical records were retrospectively reviewed for 77% of patients with hepatitis C included in the outbreak to obtain data regarding laboratory results, treatment, and outcomes. Chi-square, Fisher's exact, and Student's t-test were used to determine variables that were significantly associated with spontaneous clearance or sustained virologic response to therapy. RESULTS Fifty Caucasian patients (31 women, 19 men; mean age 52 years) were included. Eleven of 50 (22%) patients cleared HCV spontaneously (clearers). The mean age of clearers was 47 years as compared with 57 years for nonclearers (P = 0.04). Liver biopsies were obtained by treating gastroenterologists in 31 patients with mean grade and stage of 2.1 and 1.7, respectively. Gastroenterologists treated 31 of 39 patients with pegylated interferon and ribavirin after a median of 354 (range 140-1,099) days post exposure. Sustained viral response (SVR) was observed in 65% (20/31) on an intention-to-treat basis. In patients who completed therapy, 91% (20/22) achieved SVR. Age, sex, weight, pretreatment alanine aminotransferase (ALT), and histologic parameters were not associated with SVR. CONCLUSIONS In this large cohort of US immunocompetent patients with recent HCV infection, 22% resolved spontaneously. Younger age was the only predictor of spontaneous clearance. In patients with early chronic HCV, 65% achieved SVR.
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Affiliation(s)
- Javid Fazili
- Digestive Diseases, Internal Medicine, University of Oklahoma Health Sciences Center, Williams Pavilion 1360, Oklahoma City, OK 73104, USA.
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Rodríguez-Caravaca G, Villar-del-Campo MC, Casas-Losada ML, Cava-Valenciano F, Gil-de-Miguel Á. Brote de hepatitis C en una unidad de oncología. Enferm Infecc Microbiol Clin 2010; 28:233-5. [DOI: 10.1016/j.eimc.2009.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 02/02/2009] [Accepted: 02/24/2009] [Indexed: 11/17/2022]
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APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2010; 38:167-72. [PMID: 20347635 DOI: 10.1016/j.ajic.2010.01.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 01/29/2010] [Indexed: 11/21/2022]
Abstract
Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings.
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US outbreak investigations highlight the need for safe injection practices and basic infection control. Clin Liver Dis 2010; 14:137-51; x. [PMID: 20123446 DOI: 10.1016/j.cld.2009.11.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Current understanding of viral hepatitis transmission in United States health care settings indicates progress over the past several decades with respect to the risks from transfusions or blood products. Likewise, risks to health care providers from sharps injuries and other blood and body fluid exposures have been reduced as a consequence of widespread hepatitis B vaccination and the adoption of safer work practices. Increasing recognition of outbreaks involving patient-to-patient spread of hepatitis B and hepatitis C virus infections, however, has uncovered a disturbing trend. This article highlights the importance of basic infection control and the need for increased awareness of safe injection practices.
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Stevens MP, Edmond MB. Health care-associated transmission of hepatitis B and C in oncology care. Clin Liver Dis 2010; 14:69-74; viii. [PMID: 20123441 DOI: 10.1016/j.cld.2009.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The risk of acquiring hepatitis B and C in the oncology setting was historically high and predominantly related to blood product administration in the prescreening era. With the development of progressively more sophisticated testing for hepatitis B and C, breaches in infection control have played an increasingly prominent role in disease transmission. Optimizing infection control in inpatient and outpatient oncology settings is essential in preventing the health care-associated transmission of hepatitis B and C to oncology patients.
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Affiliation(s)
- Michael P Stevens
- Division of Infectious Diseases, Virginia Commonwealth University Medical Center, 1201 East Marshall Street, P.O. Box 980019, Richmond, Virginia 23298-0019, USA.
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40
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Holmberg SD. Molecular epidemiology of health care-associated transmission of hepatitis B and C viruses. Clin Liver Dis 2010; 14:37-48; vii-viii. [PMID: 20123438 DOI: 10.1016/j.cld.2009.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The term "molecular epidemiology" has been ascribed to a host of different activities that involve gene-sequence analysis. Some examples of molecular epidemiology include modeling exercises of phylogenetic trees to reconstruct epidemics; studies of the evolution of hepatitis C virus (HCV); rates of nucleotide substitution in the hepatitis B virus (HBV) surface (S) gene; variations in the core promoter/pre-core/core region of HBV genotype C from different sources; analysis of HBV surface antigen mutations; molecular clock analyses of the short-term evolution of HCV; and analyses of clades and surface antigen polymorphisms of HBV. However, for most epidemiologists molecular epidemiology of viral hepatitis usually refers to studies of gene-sequence homology in HBV or HCV recovered from people in the community or an institution that allows better characterization and assignment of related clusters of infection.
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Affiliation(s)
- Scott D Holmberg
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, TB, and STD Prevention, Centers for Disease Control and Prevention, CDC Mailstop G-37; 1600 Clifton Road, Atlanta, GA 30333, USA.
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Thompson ND, Hellinger WC, Kay RS, Cohen L, Ragan P, Voss RA, Bacalis LP, Xia G, Keating MR, Dickson RC, Hughes CB, Williams IT, Perz JF. Healthcare-associated hepatitis C virus transmission among patients in an abdominal organ transplant center. Transpl Infect Dis 2009; 11:324-9. [PMID: 19497073 DOI: 10.1111/j.1399-3062.2009.00406.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND De novo hepatitis C virus (HCV) infection among transplant patients is rarely recognized but can have severe consequences. We investigated the scope, source, and mode of HCV transmission within a transplant center after incident HCV infection was identified in 2 patients who had liver transplantation in late 2006. METHODS Patients were interviewed, and transplant logs, medical records, and staff practices were reviewed to identify opportunities for HCV transmission. Infection via receipt of blood or organs was evaluated. Molecular epidemiology was used to determine the relatedness between persons with incident and chronic HCV infection. RESULTS HCV from infected blood or organ donors was ruled out. Among the 308 patients who underwent transplant in 2006, no additional incident HCV infections were identified. Eighty-five (28%) had pre-transplant chronic HCV infection; 13 were considered possible HCV source patients based upon shared days on the inpatient unit, nursing assignment, or invasive procedures in common with incident HCV case-patients. Viral isolates from 1 HCV source patient and 1 incident case-patient were found to be highly related by quasispecies analysis, confirming patient-to-patient HCV transmission. Possible modes of transmission identified were the improper use of multidose vials, sharing of blood-contaminated glucometers, and touch contamination. CONCLUSION Sporadic transmission or endemic levels of HCV transmission might be overlooked in a setting with high HCV prevalence, such as liver transplant units, where multiple, repeated opportunities for patient-to-patient HCV transmission can occur. Surveillance through pre- and post-transplant screening is necessary to identify incident HCV infection in this setting. Constant, meticulous attention must be paid to maintaining aseptic technique and good infection control practices to eliminate HCV transmission opportunities.
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Affiliation(s)
- N D Thompson
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Mailliard ME, Capadano ME, Hrnicek MJ, Gilroy RK, Gulizia JM. Outcomes of a patient-to-patient outbreak of genotype 3a hepatitis C. Hepatology 2009; 50:361-8. [PMID: 19585621 DOI: 10.1002/hep.22992] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
UNLABELLED Between March 2000 and July 2001, at least 99 persons acquired a hepatitis C virus genotype 3a (HCV-3a) infection in an oncology clinic. This nosocomial HCV outbreak provided an opportunity to examine the subsequent clinical course in a well-defined cohort. This was a retrospective/prospective observational study of the short-term significant health outcomes of a large, single-source, patient-to-patient HCV-3a outbreak. Outbreak patients or their legal representatives consenting to study were enrolled between September 2002 and December 2007. We measured history and physical examinations, medical records, HCV serology, HCV RNA and genotype, liver enzymes, histology, response to antiviral therapy, and liver-related morbidity and mortality. Sixty-four of the 99 known HCV-3a outbreak patients participated. During a 6-year period, six patients developed life-threatening complications from liver disease, three died, one received a liver transplant, and two were stable after esophageal variceal banding or diuretic therapy of ascites. Thirty-three patients underwent antiviral therapy, with 28 achieving a sustained viral remission. One patient acquired HCV-3a infection sexually from an outbreak patient and was successfully treated. Eleven study patients died of malignancy, including two that had achieved a sustained viral remission after antiviral therapy. CONCLUSION Our patient cohort had a nosocomial source and an oncologic or hematologic comorbidity. Compared with previous HCV outcome studies, a patient-to-patient HCV outbreak in an oncology clinic exhibited significant morbidity and mortality. Attention is needed to the public health risk of nosocomial HCV transmission, emphasizing infection control, early diagnosis, and therapy.
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Affiliation(s)
- Mark E Mailliard
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA.
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Abstract
Nosocomial infections are those that become evident 48 h or more after a patient is admitted for treatment in a hospital or in another health-care setting. These infections cause substantial morbidity and mortality in patients who are immunosuppressed. Over the past few decades, understanding of host vulnerability has improved and more rigorous management and infection-control practices have been adopted for treating susceptible populations. Despite efforts, outbreaks continue to occur. In this Review, we outline current knowledge of the incidence and microbiology of various nosocomial infections in patients with cancer-a large, immunosuppressed population.
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Affiliation(s)
- Mini Kamboj
- Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Dore GJ, Haber PS. Tell me it ain't so: patient-to-patient transmission of hepatitis C in an endoscopy clinic. Hepatology 2008; 48:1333-5. [PMID: 18821606 DOI: 10.1002/hep.22595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
On January 2, 2008, the Nevada State Health Division (NSHD) contacted CDC concerning surveillance reports received by the Southern Nevada Health District (SNHD) regarding two persons recently diagnosed with acute hepatitis C. A third person with acute hepatitis C was reported the following day. This raised concerns about an outbreak because SNHD typically confirms four or fewer cases of acute hepatitis C per year. Initial inquiries found that all three persons with acute hepatitis C underwent procedures at the same endoscopy clinic (clinic A) within 35-90 days of illness onset. A joint investigation by SNHD, NSHD, and CDC was initiated on January 9, 2008. The epidemiologic and laboratory investigation revealed that hepatitis C virus (HCV) transmission likely resulted from reuse of syringes on individual patients and use of single-use medication vials on multiple patients at the clinic. Health officials advised clinic A to stop unsafe injection practices immediately, and approximately 40,000 patients of the clinic were notified about their potential risk for exposure to HCV and other bloodborne pathogens. This report focuses on the six cases of acute hepatitis C identified during the initial investigation, which is ongoing; additional cases of acute hepatitis C associated with exposures at clinic A might be identified. Comprehensive measures involving viral hepatitis surveillance, health-care provider education, public awareness, professional oversight, licensing, and improvements in medical devices can help detect and prevent transmission of HCV and other bloodborne pathogens in health-care settings.
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Affiliation(s)
- Gregory J Dore
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia
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Specific Anti Cross-Infection Measures may Help to Prevent Viral Contamination of Dental Unit Waterlines: a Pilot Study. Infection 2008; 36:467-71. [DOI: 10.1007/s15010-008-7246-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 03/03/2008] [Indexed: 10/21/2022]
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Abstract
Chronic hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with an estimated overall prevalence of 3.2 million persons (1.3%) and prevalence peaks between age 40 to 49 years (1). The worldwide prevalence of HCV infection is even higher at 2.0%, corresponding to 140 million persons (2). In terms of complications, cirrhosis due to HCV disease is the most frequent indication for liver transplantation in the United States (3), and the overall incidence of hepatocellular carcinoma, a complication of HCV cirrhosis, continues to increase at alarming rates. In an evaluation of population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program in the United States, the overall age-adjusted incidence rates of hepatocellular carcinoma increased from 1.4 per 100 000 in 1975 to 1977 to 3.0 per 100 000 in 1996 to 1998 (4).
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48
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Mosley JW, Operskalski EA, Tobler LH, Buskell ZJ, Andrews WW, Phelps B, Dockter J, Giachetti C, Seeff LB, Busch MP. The course of hepatitis C viraemia in transfusion recipients prior to availability of antiviral therapy. J Viral Hepat 2008; 15:120-8. [PMID: 18184195 DOI: 10.1111/j.1365-2893.2007.00900.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Knowing the likely distribution of intervals from hepatitis C infection to first RNA-negativity is important in deciding about therapeutic intervention. Prospectively collected sera and data from the Transfusion-transmitted Viruses Study (1974-1980) provide specific dates of infection and pattern of alanine aminotransferase (ALT) elevations. We examined frequency, timing and correlates of spontaneous resolution for 94 acutely infected transfusion recipients followed for a median of 9.5 months. Later, follow-up sera (>10 years) were available for 27 of the 94 cases from a Veterans Administration (VA) Study (1989-1990). Twenty-five (27%) of the 94 cases were classified as probably resolved during the episode itself. First RNA negativity occurred at 6-50 weeks (median, 19.5 weeks) after infection, and 5-43 weeks (median, 11 weeks) after ALT elevation. Thirteen of the 25 cases remained RNA-negative subsequently; 12 others had 1-6 RNA-positive sera intercalated between first and last RNA-negative results. RNA negativity, therefore, began variably and was interrupted in 12 cases of 25 (48%) by transient RNA-positive sera. Five of these 25 patients who were RNA-negative in the last study specimen had late, Veterans Administration Study follow-up; none showed viraemia. Of the remaining 69 transfusion transmitted virus study recipients, whose last serum was RNA-positive, two cleared viraemia after the last study serum but before late follow-up. Eleven (16%) had 23 intercalated RNA-negative sera before last positivity. RNA status, therefore, needs monitoring for many months before judging the spontaneous outcome as transient negativity may occur. Resolution was significantly more common in women and symptomatic cases; it was not associated with viral load in the infectious donation, HCV genotype, or the recipient's age.
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Affiliation(s)
- J W Mosley
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65-164. [PMID: 18068815 PMCID: PMC7119119 DOI: 10.1016/j.ajic.2007.10.007] [Citation(s) in RCA: 1689] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Wang CC, Krantz E, Klarquist J, Krows M, McBride L, Scott EP, Shaw-Stiffel T, Weston SJ, Thiede H, Wald A, Rosen HR. Acute hepatitis C in a contemporary US cohort: modes of acquisition and factors influencing viral clearance. J Infect Dis 2007; 196:1474-82. [PMID: 18008226 DOI: 10.1086/522608] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 06/01/2007] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute hepatitis C virus (HCV) infection is often asymptomatic; thus, its epidemiology and natural history are difficult to define. METHODS Acute HCV infection was identified on the basis of HCV seroconversion within 1 year (n=45), new anti-HCV seropositivity with clinical acute hepatitis (n=21), or HCV strain sequencing after an iatrogenic exposure (n=1). Risk factors were assessed with a baseline questionnaire, and participants were followed up prospectively with serial measurement of viral loads. RESULTS Of 67 persons with acute HCV infection, most were asymptomatic (64%) and injection drug users (66%). Thirteen had an unknown mode of transmission; of these, 11 reported high-risk sexual behavior. Ten acquired acute HCV infection within 3 months of an iatrogenic exposure; 3 had confirmed iatrogenic infection, and 4 had no other risk factors identified. The spontaneous viral clearance rate after 6 months of infection was 18% (95% confidence interval, 11%-31%). The rate of viral clearance varied significantly by sex (34% vs. 3% for women vs. men; P<.001). CONCLUSIONS High-risk sexual or iatrogenic exposures may be important contemporary risk factors for HCV infection. The spontaneous viral clearance rate (18%) in this contemporary study was similar to that reported for past studies of transfusion-associated HCV infection. Women were more likely to clear acute HCV infection than men.
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Affiliation(s)
- Chia C Wang
- Department of Medicine, Division of Infectious Diseases, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA.
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