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A Large Nosocomial Outbreak of Hepatitis C and Hepatitis B Among Patients Receiving Pain Remediation Treatments

R. Dawn Comstock , PhD, Sue Mallonee , RN, MPH, Jan L. Fox , RN, Ronald L. Moolenaar , MD, MPH, Tara M. Vogt , PhD, Joseph F. Perz , DrPH, Beth P. Bell , MD, MPH and James M. Crutcher , MD, MPH
Infection Control and Hospital Epidemiology
Vol. 25, No. 7 (July 2004), pp. 576-583
DOI: 10.1086/502442
Stable URL:
Page Count: 8
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A Large Nosocomial Outbreak of Hepatitis C and Hepatitis B Among Patients Receiving Pain Remediation Treatments
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BACKGROUND AND OBJECTIVE.  In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak’s extent and etiology. DESIGN, SETTING, AND PARTICIPANTS.  We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection. RESULTS.  Of 908 patients, 795 (87.6%) were tested, and 71 HCV‐infected patients (8.9%) and 31 HBV‐infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV‐infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4–15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3–6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe–needle to sequentially administer sedation medications to every treated patient each clinic day. CONCLUSIONS.  Reuse of needles–syringes was the mechanism for patient‐to‐patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.

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