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A Large Nosocomial Outbreak of Hepatitis C and Hepatitis B Among Patients Receiving Pain Remediation Treatments

Published online by Cambridge University Press:  02 January 2015

R. Dawn Comstock ,
Sue Mallonee ,
Jan L. Fox ,
Ronald L. Moolenaar ,
Tara M. Vogt ,
Joseph F. Perz ,
Beth P. Bell  and
James M. Crutcher
R. Dawn Comstock*
Affiliation:
Oklahoma State Department of Health, Oklahoma City, Oklahoma Epidemiology Program Office, Division of Applied Public Health Training, Atlanta, Georgia
Sue Mallonee
Affiliation:
Oklahoma State Department of Health, Oklahoma City, Oklahoma
Jan L. Fox
Affiliation:
Oklahoma State Department of Health, Oklahoma City, Oklahoma
Ronald L. Moolenaar
Affiliation:
Epidemiology Program Office, Division of Applied Public Health Training, Atlanta, Georgia
Tara M. Vogt
Affiliation:
National Center for Infectious Diseases, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Joseph F. Perz
Affiliation:
National Center for Infectious Diseases, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Beth P. Bell
Affiliation:
National Center for Infectious Diseases, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
James M. Crutcher
Affiliation:
Oklahoma State Department of Health, Oklahoma City, Oklahoma
*
Oklahoma State Department of Health, 1000 N.E. 10th Street, Oklahoma City, OK 73117
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Abstract

Background and Objective:

In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology.

Design, Setting, and Participants:

We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection.

Results:

Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4–15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3–6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe–needle to sequentially administer sedation medications to every treated patient each clinic day.

Conclusions:

Reuse of needles–syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 7 , July 2004 , pp. 576 - 583
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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