Arianne Folkema1, Hsiu-Li Wang1,2, Kristy Wright1, M Mustafa Hirji2,3, Anton Andonov4, Kathryn Bromley1, Chad Ludwig1, Amy MacArthur1. 1. Region of Waterloo Public Health and Emergency Services, Waterloo, ON. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON. 3. Niagara Region Public Health & Emergency Services, Thorold, ON. 4. National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB.
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.
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.
Entities:
Keywords:
HCV; IPAC; contamination; infection prevention and control practices; out-of-hospital healthcare settings; outbreak
Authors: Rebecca D Greeley; Shereen Semple; Nicola D Thompson; Patricia High; Ellen Rudowski; Elizabeth Handschur; Guo-Liang Xia; Lilia Ganova-Raeva; Jennifer Crawford; Corwin Robertson; Christina Tan; Barbara Montana Journal: Am J Infect Control Date: 2011-06-12 Impact factor: 2.918
Authors: Joseph R Coyle; Emily Goerge; Kathryn Kacynski; Ruby Rodgers; Patricia Raines; Linda S Vail; Sugandha Lowhim Journal: Pain Med Date: 2017-02-01 Impact factor: 3.750
Authors: R Dawn Comstock; Sue Mallonee; Jan L Fox; Ronald L Moolenaar; Tara M Vogt; Joseph F Perz; Beth P Bell; James M Crutcher Journal: Infect Control Hosp Epidemiol Date: 2004-07 Impact factor: 3.254