New health study focuses on hepatitis spread

By Mary Manning

Tuesday, Jan. 6, 2009 | 12:16 p.m.

In the past 10 years, more than 60,000 patients across the United States were asked to go for tests for hepatitis B virus and hepatitis C virus because health care providers outside hospitals failed to follow basic infection control practices, says a new study by the Centers for Disease Control and Prevention.

Two outpatient endoscopy centers in Las Vegas have been directly linked to 114 cases of hepatitis C cases last year, making it the largest outbreak of the blood-borne illness in the country. At least 40,000 patients who underwent procedures at the two local clinics were at risk, the review said. A total of 12,000 local patients were screened for hepatitis B, C and the HIV virus.

The CDC published its findings on Monday in the journal Annals of Internal Medicine.

This is the first full review by the national health agency during the past decade of health care links outside of hospitals associated with viral hepatitis outbreaks.

"This report is a wake-up call," said Dr. John Ward, director of CDC's Division of Viral Hepatitis. "Thousands of patients are needlessly exposed to viral hepatitis and other preventable diseases in the very places where they should feel protected. No patient should go to their doctor for health care only to leave with a life-threatening disease."

In the U.S., transmission of hepatitis B or C while receiving health care has been considered uncommon, the CDC report said. However, the CDC's review revealed a total of 33 identified outbreaks — including the Southern Nevada outbreak — occurred outside of hospitals in 15 states. A dozen occurred in outpatient clinics, six in hemodialysis centers and 15 in long-term care facilities, resulting in 450 people infected with hepatitis B or C.

Patients were exposed to these potentially deadly diseases because health care personnel failed to follow basic infection control procedures and aseptic techniques in injection safety, the review said. Reuse of syringes and blood contamination of medications, equipment and devices were identified as common factors in these outbreaks, including the Las Vegas outbreak.

"More and more patients in the United States receive their health care in outpatient settings," said Dr. Denis Cardo, director of CDC's Division of Healthcare Quality Promotion. "To protect patients, infection control training, professional oversight, licensing, innovative engineers controls and public awareness are needed in these health care settings."

CDC officials say the report shows the need for ongoing professional education for health care providers, as well as consistent state oversight in detecting and preventing the transmission of bloodborne pathogens in health care settings.

In July, the Southern Nevada Health District reported that it had identified two source cases related to the Endoscopy Center of Southern Nevada outbreak at 700 Shadow Lane, where seven cases were tied to the outbreak. Another two cases were linked to the Desert Shadow Endoscopy Center at 4275 Burnham Ave. Both clinics have been closed.

CDC assists local health departments by providing routine surveillance, outbreak investigation support, field scientists and lab expertise. The CDC partnered with the Southern Nevada Health District and the Nevada State Health Division in the Las Vegas outbreak.

As a result of the Las Vegas outbreak and the decade-long review, the CDC plans to support health departments to identify infected persons, strengthen state and local prevention programs, collect outpatient information through national surveillance, update patient education, continue educational outreach for injection safety practices and promote safe care practices outside hospitals and work with regulators to strengthen licensing and accreditation processes with emphasis on safe injection practices.