Hepatitis C Transmisson In A Clinical Setting "How Safe Are We ?"
Today this website takes a closer look at the transmission of Hepatitis C, using statistics/data from medical journals, and credible online sources including Reuters and Associated Press.
This information will also include the recent rise in HCV transmissions through dental and or medical procedures. . The recent cases of HCV infections transmitted via a clinical setting have caused the public to question their own safety in regard to the transmission of all bloodborne pathogens while undergoing future medical procedures.
In a few of these clinical settings innocent patients were infected with HCV via contaminated syringes, with the drug Fentanyl named at three different clinics; Mayo, Rose Medical Center and Riverside Regional. Apparently in all three cases the guilty parties stole syringes and injected themselves with the painkiller fentanyl replacing the syringes with saline to be reused on patients. We can only surmise how often this has played out across the country in other hospitals or clinics. All three guilty parties were infected with HCV, although not all admitted to knowing it.
Transmission Of The Hepatitis C Virus
The Hepatitis C virus is spread from blood-to-blood contact. Today the most common route of transmission is by sharing needles or other equipment to inject drugs. However, before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.
Strictly speaking according to the CDC, and data published in the September 2010 issue of Virology Journal people who are at risk for contracting the Hepatitis C virus are as follows; .
Sharing needles, syringes, or other equipment to inject drugs
An estimated 60% of intravenous recreational drug users in the United States have been infected with HCV.
In February Johns Hopkins School of Public Health reported; "Among injection drug users, new cases of HIV infection have declined dramatically in the past two decades, but the number of new infections from the hepatitis C virus have dropped only a small amount. The researches noted; " With IV use on the rise and the fact that sharing a needle just one time can transmit the virus, researchers warn that "HCV is nearly 10 times more transmissible by IV use than HIV."
For instance, in rural southern Ohio's Scioto County IV use is thriving, with oxycodone being the drug of choice. Reported back in December by the Associated Press; "Scioto County's per capita rates of murder, fatal overdoses and hepatitis C infections have in recent years been outranked only by Ohio's biggest urban areas. The DEA considers the county one of the worst places in the country for prescription painkiller abuse, with more people abusing per capita than almost anywhere else." ...
Needle stick injuries In A Clinical Setting
HCV transmission is a risk to health care workers through accidental exposure to blood through needle sticks or blood spatter to the eyes or open wounds. The transmission of HCV in a health care setting through needle stick injuries is approximately 5% .
Sharps Injuries Remain Danger, Despite Interventions
Dec 2010 / Sandhya George .
Surgical teams in hospitals have not seen fewer sharps injuries since legislation was passed 10 years ago to mandate safety procedures, according to researchers. In fact, the rate of injury has increased. Investigators found that, after the Needlestick Safety and Prevention Act was passed in 2000, and despite widely available safety-engineered instruments, sharps injury increased among surgical staff by 6.5% whereas it decreased among nonsurgical personnel by 31.6%.
Surgeons and surgical residents and fellows represented more than one-third of reported surgical injuries (15.6% and 17%, respectively), although surgical technicians and operating room nurses were the groups most likely to be injured (37.1% and 30.3%, respectively).
Injuries occurred mostly when suture needles (43.4%), scalpel blades (17%) and syringes (12%) were used or passed between members of the team.“Focusing on suture needles as the predominant cause of injury in surgical settings presents the greatest opportunity for injury reduction in the operating room,” the authors wrote. “Proven strategies for reducing suture needle injuries include substituting blunt suture needles for sharp ones when suturing less dense tissues.”Adding weight to their recommendation, the authors cited a 2005 statement from the American College of Surgeons supporting “the universal adoption of blunt suture needles as the first choice for fascial suturing.” . Every year, more than 380,000 percutaneous injuries are reported by U.S. hospital workers, and surgical personnel underreport these injuries by more than 50%, the authors said. In this study of injury data from 87 hospitals in 11 states between 1993 and 2006, there were 7,186 injuries from sharp instruments in surgical settings and 24,138 in nonsurgical settings.
The study was published in the Journal of the American College of Surgeons (Jagger J et al. 2010;210:496-502) .
Mother To Child Transmission
3% to 5% infants who acquire HCV from infected mother by perinatal transmission
HCV is present in saliva and milk but the transfer of HCV infection through breast milk has not been reported.
Risk Factors for Mother-to-child Transmission of Hepatitis C Virus
By Liz Highleyman
Hepatitis C virus (HCV) infection in children is mainly acquired via mother-to-child (perinatal) transmission. In a study published in the August 20,2007 issue of AIDS, French researchers sought to identify risk factors for mother-to-child HCV transmission, in particular those associated with maternal virological characteristics or mode of delivery.
The investigators included 214 HCV positive women and their newborn infants seen at 6 hospitals in southern France between October 1998 and September 2002. About one-quarter (55%) of the women were HIV-HCV coinfected. The authors collected data on maternal characteristics, circumstances of delivery, and laboratory data for the mothers and children. All babies were followed for 1 year, and those with detectable plasma HCV RNA for 2 years.
Please See HIV and Hepatitis For Complete Results
Razors, Toothbrushes, Body Piercing, Acupuncture or Tattoos
Although rare, personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment can easily be contaminated with blood. Sharing such items can potentially lead to exposure to HCV.
However, studies are thinly distributed on household transmission of HCV. At Medscape you can find a paper published in the Journal of Viral Hepatitis in 2006 which tested the saliva of thirty patients with chronic hepatitis C before and after toothbrushing. Results were; In nine patients (30%), the saliva before toothbrushing was positive for HCV-RNA, and in 11 patients (36.7%) HCV-RNA was detected in the saliva after toothbrushing. Five of these 11 patients tested negative for saliva samples before toothbrushing. HCV-RNA polymerase chain reaction (PCR) was positive in as many as 12 of 30 specimens (40%) of the toothbrush rinsing water specimens . In six of these 12 patients, the saliva before toothbrushing had been negative for HCV-RNA.
The study concluded; "The mere finding of HCV-RNA on the surface of contaminated tools does not prove potential transmission of the virus by these tools, of course, and the low infection risk usually published for household contacts of hepatitis C patients provides good evidence against a significant role of transmission by household objects. Nevertheless, our data prove a possible contamination of personal care objects, suggesting at least a theoretical risk of infection by sharing them. Thus, our study strengthens the recommendations to pay attention to a clear separation of personal care objects between patients and their household members. Considering the great epidemiological importance of hepatitis C, further examinations and maybe even official instructions concerning publically used and possibly contaminated objects such as razors in barbershops are indicated."
In 2010 Reuters reported on the" acupuncture-related infection" editorial published in the British Medical Journal. According to the researchers at Hong Kong University, which prompted the editorial; "The number of reported acupuncture-related infections worldwide was the tip of an iceberg and they called for tighter infection control measures." Also noted in the editorial were at least five outbreaks of HBV infection that were linked via acupuncture. The data warned of the possibility of transmission of hepatitis C and HIV. However, the paper also noted; "Although no clear evidence exists to support a link between acupuncture and HIV infection, there are reports of patients with HIV who had no risk factors other than acupuncture.
Tattoos and Body Piercing
Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. The U.S. Centers for Disease Control and Prevention's position on this subject states that, "Whenever tattoos or body piercings are performed in informal settings or with nonsterile instruments, transmission of hepatitis C and other infectious diseases is possible." Despite these risks, it is rare for tattoos in an approved facility to be directly associated with HCV infection.
Community barbershops also play a key role in HCV transmission in under development countries .
Sexual Transmission Of Hepatitis C In Heterosexual, Monogamous Relationships
Studies show the risk of sexual transmission in heterosexual, monogamous relationships is extremely rare.
Unlike HBV, the transmission of Hepatitis C infection is less frequently transmitted through sexual or intimate contact, the risk for transmission is at (0.4 to 3%).
From The Website Site: Sex and Hepatitis C
The Spread of hepatitis C (HCV) via sexual relationship .
Is heterosexual transmission an important risk factor for hepatitis C?
M. Klevens, D. Daniels, K. Iqbal, C. Vonderwahl. Survey by CDC and various state health departments (2010) Quote: Most acute HCV cases and (those with more than one) heterosexual partners also had other risks. Heterosexual transmission may not be an important risk factor."
Molecular Evidence of Horizontal Transmission of Hepatitis C Virus Within Couples
Isabel Maria Vicente Guedes de Carvalho-Mello, Jose Eymard Medeiros Filho ... Butantan Institute, University of São Paulo, Brazil (2009). Quote: "Nine couples with a stable relationship and without other risk factors for HCV infection and 42 control patients were selected ... a common source of infection was observed in both members of five couples. These data strongly support HCV transmission within couples."
(Study of commercial sex workers in South Korea)
Seun-Seog Kweon, Min-Ho Shin. Seonam University College, South Korea ... (2006). Quote: "None of the variables associated with sexual activity ... were associated with the presence of antibodies to HCV. ... Although we cannot rule out the role of sexual activity as an independent risk factor for HCV infection, we suggest that sexual activity is less of a risk factor than are acupuncture or diabetes ... "
Sexual Transmission of Hepatitis C among HIV Positive Men in the U.S. and Australia .
HIV and Hepatitis reported on the results of two studies published online in the 2011 issue of Clinical Infectious Diseases . The first study in Australia; Patterns and Characteristics of Hepatitis C Transmission Clusters among HIV-Positive and HIV-Negative Individuals in the Australian Trial in Acute Hepatitis C , the second study from the U.S., Incident Hepatitis C Virus Infection among US HIV-Infected Men Enrolled in Clinical Trials .
In Summary By Liz Highleyman at HIV and Hepatitis; Nearly three-quarters of new hepatitis C virus (HCV) infections among HIV positive gay and bisexual men in the U.S. are likely due to sexual transmission, according to an analysis described in the January 31, 2011 advance online issue of Clinical Infectious Diseases. An Australian study published in the same issue found that sexual transmission accounted for a majority of cases among men who have sex with men, but injection drug use also played a role. These findings suggest that HIV positive people who have risky sex should undergo regular hepatitis C testing.
See Full Data At HIV and Hepatitis .
Transmission Of Hepatitis C Dental and Medical Procedures In A Clinical Setting
Some other reported risk factors of disease transmission are dental or surgical procedures and dialysis . In a study conducted on 3351 patients of HCV in Pakistan it has been documented that more than 70% hepatitis C infections are spread in hospitals by the use of same needle several times and major or minor operations that are extremely frequent in Pakistan. Globally reuse of needles is also common source of transmission. Here in the U.S. transmission of Hepatitis C or other bloodborne pathogens reported in nonhospital medical settings seem to be increasing as shown below in the paper originally published in Journal Watch Infectious Diseases
July 21, 2010
Hepatitis C Virus Transmission at an Endoscopy Clinic .
Eight cases were identified; contamination and reuse of open propofol vials was the likely source.
Hepatitis C is the most common bloodborne infection in the U.S. Although nosocomial transmission of hepatitis C virus (HCV) is considered rare, the number of cases associated with nonhospital medical settings is increasing.
2007 - Researchers describe an outbreak of HCV infection at an endoscopy clinic:
During a 5-week period in 2007, three patients developed acute hepatitis after undergoing endoscopy at a single clinic in Las Vegas. Among the 123 additional patients who underwent endoscopy at that clinic on the same dates as these individuals, 6 were known to be HCV infected and were considered potential source patients; the remaining 117 were advised to undergo screening for antibodies to HCV. This testing identified an additional five patients who met the case definition for clinic-acquired HCV infection. .
Genetic analysis of the HCV from the eight patients with clinic-acquired infections and from the six patients known to have been infected before their procedures allowed the identification of the source patient for each endoscopy date. Among HCV-susceptible individuals who underwent endoscopy after the source patients, HCV infection developed in 1 of 49 (2%) whose procedures occurred on the first date and in 7 of 38 (18%) whose procedures occurred on the second date.
During the investigation, an anesthetist was observed placing a new needle on a syringe, then refilling the syringe from a propofol vial that was intended for single use but had been used for other patients. . Comment: This outbreak of HCV infection was likely related to contamination of open propofol vials through refilling of syringes that had become contaminated with the source patients' blood. This practice was routine in the clinic, so it is surprising that more infections did not occur.
— Neil M. Ampel, MD
Fischer GE et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007–2008. Clin Infect Dis 2010 Aug 1; 51:267.
Original article (Subscription may be required)
Medline abstract (Free)
Surgical Tech Indicted for Spreading Hepatitis C to Patients
In January of 2010 Kristen Diane Parker, 26, was arrested after knowingly using tainted needles on surgical patients at two hospitals where she worked. Parker previously worked at facilities in New York and Texas, raising the amount of patients who may have been exposed to hepatitis C. She is accused of knowing that she was hepatitis C-positive while working at the hospitals.
Parker allegedly stole syringes to inject herself with the painkiller fentanyl then replacing them with saline and potentially infecting countless others.
As many as 6,000 patients who underwent surgeries at the Colorado hospitals while Parker was working there have been notified and offered free blood tests to determine whether they were infected.
Nurse May Have Infected 300 in Virginia With Hepatitis C
In the spring of 2008; Assoicated Press
At least 15 military service members or their relatives are believed to have been infected with hepatitis by a nurse suspected of stealing their painkillers during surgery. The nurse, retired Army captain Jon Dale Jones, was arrested this month in Miami on federal charges of assaulting three of those patients and possession of a controlled substance by fraud. Federal prosecutors said they believe Jones spread the disease in 2004 during surgeries at an El Paso military hospital by diverting fentanyl - a powerful painkiller often used for anesthesia - from patients to himself. The outbreak - and the nearly three-year-long criminal investigation that followed - apparently did not prevent Jones from continuing to work as nurse in Texas and at least two other states and Washington, D.C.
Officials at Riverside Regional Medical Center in Newport News said Jones worked there from July through December. Staff members have identified 310 patients who came into contact with Jones and asked them to return for tests for hepatitis C.
Hepatitis C Virus Transmission at an Outpatient Hemodialysis Unit - New York, 2001-2008 .
According to the CDC in July 2008, the New York State Department of Health (NYSDOH) received reports of three hemodialysis patients seroconverting from anti-hepatitis C virus (HCV) negative to anti-HCV positive in a New York City hemodialysis unit during the preceding 6 months.
NYSDOH conducted patient interviews and made multiple visits to the hemodialysis unit to observe hemodialysis treatments, assess infection control practices, evaluate HCV surveillance activities, review medical records, and conduct interviews with staff members. This report summarizes the results of that investigation, which found that six additional patients had HCV seroconversion during 2001--2008 and that the hemodialysis unit had numerous deficiencies in infection control policies, procedures, and training. Of the total of nine seroconversions, the sources for four HCV infections were identified phylogenetically and epidemiologically as four other patients in the unit. The unit's policy for routine patient testing for HCV infection was not in accordance with CDC recommendations, and the few recommendations followed were not implemented consistently. Hemodialysis units should routinely assess compliance to ensure complete and timely adherence with CDC recommendations to reduce the risk for HCV transmission in this setting.
The hemodialysis unit was a large, for-profit, outpatient facility treating 70--100 patients daily at 30 dialysis stations. On May 24, 2008, the New York City Department of Health and Mental Hygiene informed NYSDOH of a confirmed HCV seroconversion in one patient receiving chronic hemodialysis treatment at the unit. On July 1, the unit reported two additional HCV seroconversions directly to NYSDOH. Interviews conducted by NYSDOH with the three patients who seroconverted revealed no other common health-care exposures or behavioral risk factors. In addition, none of the three had been informed by the hemodialysis unit of their HCV infections. Initial site visit findings by NYSDOH documented poor infection control practices and oversight. Specific recommendations addressing deficiencies were provided to the unit's administrative staff members at the initial site visit and throughout the investigation. An epidemiologic investigation subsequently was undertaken to identify additional patients with HCV infection, assess infection control practices, and make recommendations to prevent ongoing transmission. You can read the full report here.
Free dental clinic may have spread hepatitis B
Nearly 2,000 people in 5 states urged to get testing for blood-borne disease
In 2009 during the “Mission of Mercy” dental clinic in West Virgina, resulted in five cases of acute Hepatitis B. Three were patients and two were clinic volunteers. The clinic was held in a temporary dental setting without an infection preventionist involved. The investigators suggested that some of the equipment was not sterilized properly or was not functioning correctly. Notification letters were sent out to 1,137 patients and 826 volunteers. The letters recommended testing for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).
Florida Mayo Clinic patients infected with Hepatitis C
"Steven Larry Beumel, 47, admitted he diverted Fentanyl while working at the hospital, according to the police report." .
In August of 2010 at the Mayo Clinic in Jacksonville Florida three patients and possibly more were infected with hepatitis C after a medical worker injected himself with drugs meant for the patients. Mayo said "the employee, who had hepatitis, filled the emptied painkiller syringes with saline and left them to be used on the patients. They said that created a means of transmitting the disease despite him changing the needles." Read the article reported by the Jacksonville columnist Jeremy Cox online here . .
Veterans Affairs Medical Center In Feburary 2011 The John Cochran Veterans Affairs Medical Center had canceled all surgeries until further notice after discovering that some surgical equipment may not have been properly sterilized.
Last June, the hospital had to offer 1,800 patients of its dental clinic free testing for hepatitis and HIV after revealing it had not followed proper sterilization procedures on equipment at the clinic. Four veterans tested positive for hepatitis, but it's not clear if those cases are connected to the dental clinic.