Two patients at Brantford General Hospital in Ontario, Canada may have acquired hepatitis C due to cross-contamination of medication supplies while undergoing endoscopies.
Dr. Tom Szakacs, an infection control specialist at BGH, told the Brantford Expositor that medications used in sedation during endoscopies must be carefully documented, including the type of drug and dose. He said that in some cases “some pieces of information were not there.”
Szakacs says they are investigating whether the needle used to inject sedative medications on a patient previously infected with hepatitis C was then used on the next patient causing transmission of the virus.
Alternatively, says Szakacs, “if sterile technique is not followed, it may cause contamination of a stock medication vial that is then the source of virus for the next patient.”
At this time, the Brant Community Healthcare System said in a news release that it has ruled out other potential sources of contamination, such as scopes or the medications themselves.
“We are confident that our exhaustive investigation has shown where there could have been a possible breach, and we are putting in place evidence-based recommendations that will ensure patient safety,” says Szakacs.
“This situation is not unique and has been reported elsewhere. Staff and physicians at BCHS are dedicated to improving infection control practices for our patients.”
The hospital is now resuming elective endoscopy procedures at the hospital.
“The decision to resume endoscopy procedures was made with confidence as it was found through an internal investigation that equipment used in BGH endoscopy procedures is fully cleaned and sterilized,” says Szakacs.
He says infection control specialists examined all staff and physician practices, sterilization techniques and medication administration.
The investigation involved two patients who underwent endoscopies at the hospital last year on May 29 and Nov. 8. An endoscopy involves examining the inside of a person’s body using a medical device consisting of a long thin tube, which has a light and a video camera.
In mid-November, the hospital became aware of a patient who had recently acquired hepatitis C, who had an endoscopy procedure on May 29. Szakacs says the hospital began an immediate investigation into whether this was a possible transmission case.
He says it couldn’t be deemed a “probable” transmission until January when blood results from the investigation became available. After exposure to hepatitis C, it can take up to six months for laboratory testing to confirm infection. Due in part to this lag time, says Szakacs, the first case related to endoscopy in May wasn’t identified until November.
Other endoscopy patients from May 29 from the same procedure room were tested for hepatitis C. The patient immediately preceding the affected patient had hepatitis C prior to the endoscopy. All other patients from that day in that procedure room were cleared of hepatitis C, as well as other blood-borne viruses.
In January, the hospital became aware of an additional patient who recently acquired hepatitis C, who had an endoscopy procedure on Nov. 8.
Similar to the testing from patients with endoscopies in May, the patient immediately preceding this newly affected patient had hepatitis C, which is also believed to have been pre-existing. All other patients who had procedures on that day in the same room tested negative.
Samples of the infected patients from the May 29 and Nov. 8 days have been forwarded to the National Microbiology Laboratory in Winnipeg. The genetics of the viruses are being analyzed. The results will be able to confirm whether the viruses are identical and whether transmission did occur. It could be a week or more before the results are known.
If a transmission is confirmed by the national laboratory, the Brant Community Healthcare System will extend testing and examination to additional endoscopy patients who may have been at risk, says Jim Hornell, president and CEO of BCHS.
“In addition to our internal investigations we are working collaboratively with the Brant County Health Unit,” says Hornell.
“Any new information or actions we may take will be communicated to the communities we serve. We are committed to putting patients first and being as open and transparent as possible.”
Hornell says the hospital will be implementing recommendations for future endoscopies, including:
• Implementation of explicit and comprehensive guidelines on the preparation, labelling, delivery, storage, documentation, and discarding of all medications used in endoscopy.
• Additional training on sterile techniques for all staff involved in endoscopies.
• Implementation of additional guidelines in the storage, sterilization and disinfection of equipment — above and beyond standard practice.
• Additional personal protective equipment training and measures.
Hepatitis C is a viral infection carried in the blood, affecting primarily the liver. The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis or liver cancer, which generally takes more than 10 years to develop. About 75% of people show no signs or symptoms of infection.
Release Date: January 21, 2014
Source: Brantford Expositor