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多起与门诊内镜检查麻醉相关的肝炎病毒感染集群。

Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures.

机构信息

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

Gastroenterology. 2010 Jul;139(1):163-70. doi: 10.1053/j.gastro.2010.03.053. Epub 2010 Mar 27.

Abstract

BACKGROUND & AIMS: Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted during administration of intravenous anesthesia when medication vials are used for multiple patients using incorrect technique. We investigated an outbreak of acute HBV and HCV infections among patients who received anesthesia during endoscopy procedures from the same anesthesiologist (anesthesiologist 1), in 2 different gastroenterology clinics.

METHODS

Chart reviews, patient interviews, clinic site visits and infection control assessments, and molecular sequencing of patient isolates were performed. Patients treated by anesthesiologist 1 on specific procedure days were offered testing for blood-borne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed.

RESULTS

Six cases of outbreak-associated HCV infection and 6 cases of outbreak-associated HBV infection were identified in clinic 1. One outbreak-associated HCV infection was identified in clinic 2. HCV quasispecies sequences from the patients were nearly identical (96.9%-100%) to those from source patients with chronic viral hepatitis. All affected patients in both clinics received propofol from anesthesiologist 1, who inappropriately used a single-patient-use vial of propofol for multiple patients. Reuse of syringes to redose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission.

CONCLUSIONS

Twelve persons acquired HBV and HCV infections (6 hepatitis C, 5 hepatitis B, and 1 coinfection) in 2 separate offices as a result of receiving anesthesia from anesthesiologist 1. Gastroenterologists are urged to review carefully the injection, medication handling, and other infection control practices of all staff under their supervision, including providers of anesthesia services.

摘要

背景与目的

当使用不当技术为多名患者使用同一药物瓶进行静脉麻醉时,乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)可能会在给药过程中传播。我们调查了在同一位麻醉师(麻醉师 1)进行内镜检查程序期间接受麻醉的患者中发生的急性 HBV 和 HCV 感染暴发,这些患者来自两个不同的胃肠病诊所。

方法

进行了图表审查、患者访谈、诊所现场访问和感染控制评估,以及患者分离株的分子测序。为麻醉师 1 在特定手术日治疗的患者提供血液传播病原体检测。审查了内镜和麻醉程序;进行了 HCV 准种分析。

结果

在诊所 1 发现了 6 例暴发相关 HCV 感染和 6 例暴发相关 HBV 感染。在诊所 2 发现了 1 例暴发相关 HCV 感染。来自患者的 HCV 准种序列与慢性病毒性肝炎的源患者几乎完全相同(96.9%-100%)。两个诊所的所有受影响患者均接受了麻醉师 1 提供的丙泊酚,而麻醉师 1 不当使用了单患者使用的丙泊酚瓶为多名患者重复用药。重新使用注射器为患者重新给药,导致随后患者使用的药物瓶受到污染,可能导致病毒传播。

结论

由于从麻醉师 1 接受麻醉,在两个独立的办公室中,12 人感染了乙型肝炎病毒和丙型肝炎病毒(6 例丙型肝炎,5 例乙型肝炎,1 例合并感染)。敦促胃肠病学家仔细审查所有受其监督的人员(包括麻醉服务提供者)的注射、药物处理和其他感染控制措施。

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