Results from a Large-Scale Epidemiologic Look-Back Investigation of Improperly Reprocessed Endoscopy Equipment

2012 ◽  
Vol 33 (07) ◽  
pp. 649-656 ◽  
Author(s):  
Mark Holodniy ◽  
Gina Oda ◽  
Patricia L. Schirmer ◽  
Cynthia A. Lucero ◽  
Yury E. Khudyakov ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Large Scale ◽  
Bloodborne Pathogens ◽  
Medical Centers ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Viral Testing ◽  
Veterans Affairs Medical Centers ◽  
High Level ◽  
Nose And Throat

Objective.To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.Design.Retrospective cohort study.Setting.Four Veterans Affairs medical centers (VAMCs).Patients.Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.Methods.Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.Results.Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.Conclusions.Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

Results from a Large-Scale Epidemiologic Look-Back Investigation of Improperly Reprocessed Endoscopy Equipment

2012 ◽  
Vol 33 (7) ◽  
pp. 649-656 ◽  
Author(s):  
Mark Holodniy ◽  
Gina Oda ◽  
Patricia L. Schirmer ◽  
Cynthia A. Lucero ◽  
Yury E. Khudyakov ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Large Scale ◽  
Bloodborne Pathogens ◽  
Medical Centers ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Viral Testing ◽  
Veterans Affairs Medical Centers ◽  
High Level ◽  
Nose And Throat

Objective.To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.Design.Retrospective cohort study.Setting.Four Veterans Affairs medical centers (VAMCs).Patients.Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.Methods.Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.Results.Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.Conclusions.Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

Reuse of Insulin Pens Among Multiple Patients at 2 Veterans Affairs Medical Centers

2015 ◽  
Vol 36 (10) ◽  
pp. 1121-1129
Author(s):  
Patricia Schirmer ◽  
Carla A. Winston ◽  
Cynthia Lucero-Obusan ◽  
Mark Winters ◽  
Alan Lesse ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis B Virus ◽  
Veterans Affairs ◽  
Medical Centers ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Strain Testing ◽  
Veterans Affairs Medical Centers ◽  
Insulin Pens ◽  
Multiple Patients

OBJECTIVETo determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP).DESIGNRetrospective cohort study.SETTINGTwo Veterans Affairs medical centers.PATIENTSVeterans who received insulin via insulin pens from 2010 to 2013.METHODSPatients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing.RESULTSOf 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness.CONCLUSIONSOur investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.Infect Control Hosp Epidemiol 2015;36(10):1121–1129

Needlestick Prevention Devices: A Pointed Discussion

1992 ◽  
Vol 13 (5) ◽  
pp. 295-298 ◽  
Author(s):  
Sue Crow ◽  
Lee Wugofski
Keyword(s):  
Occupational Safety ◽  
Work Practice ◽  
Cost Effective ◽  
Bloodborne Pathogens ◽  
Hiv Epidemic ◽  
Safety And Health ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Ultimate Question ◽  
Selection Of

Institutions and employees in the healthcare industry recently have been flooded with a variety of new preventive devices, with the promise of reducing the risk of needlestick accidents. With the known risk of occupational human immunodeficiency virus (HIV) infection and the greater risk of morbidity and mortality of occupational hepatitis B virus (HBV) infection, it is hard not to get swept away by the tsunami of “safer devices.” The ultimate question of course, is whether these new or improved products actually contribute to the reduction of accidents and diminish the transmission of these diseases. With the demand for safer working conditions in the context of the HIV epidemic and in times of shrinking budgets, the safest and most cost-effective devices must be determined. Although the Occupational Safety and Health Administrations (OSHA) final ruling on occupational exposure to bloodborne pathogens may not directly address the issue of needlestick prevention devices, institutions should be prepared to justify their practices and selection of equipment, given its emphasis on engineering and work practices that states “Engineering and work practice controls shall be used to eliminate or minimize employee exposure.”

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