The Southern Nevada Health District is advising patients who received injected anesthesia medication at the Endoscopy Center of Nevada (700 Shadow Lane) of a risk for possible exposure to hepatitis C and other bloodborne pathogens.

The health district is recommending patients who had procedures requiring injected anesthesia at the clinic between March 2004 and January 11, 2008, contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV.

Reports

• Final Hep C Investigation Report PDF 6 MB
• Interim Hep C Investigation Report PDF 55 KB
• Morbidity and Mortality Weekly Report PDF 385 KB

Overview of Investigation

• How were the cases discovered?
• How were patients exposed?
• What actions have been taken to correct the unsafe injection control practices?
• Why is the health district also recommending testing for hepatitis B and HIV?
• How serious are these illnesses?
• What is the Southern Nevada Health District’s role in the response?
• Are these types of medical procedures safe?
• What are the recommendations for people who test positive for hepatitis C, B or HIV?

Why is the health district making these recommendations?

• The health district received notification of three acute cases of hepatitis C in January 2008 and has identified a total of six cases to date. Five of the cases had procedures requiring injected anesthesia on the same day.
• Following a joint investigation with the Nevada State Bureau of Health Care Quality and Compliance and with consultation from the Centers for Disease Control and Prevention, the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients.
• The exposures did not result from the medical procedures performed.

How were the cases discovered?

• The cluster of illnesses came to the attention of the health district in January 2008.
• These cases were reported to the health district by area physicians.
• Nevada law requires that medical providers notify public health officials when they identify a number of different diseases, including hepatitis C.
• The common link between cases was identified through the routine investigation of the cases reported by medical providers, which includes an interview of the patient.

Why did it take several months for this to come to the attention of the health district?

• Most people infected with hepatitis C virus do not develop symptoms and do not know that they have been infected. As a result, these infections would not have been reported to the health district.
• An infection with hepatitis C that results in the patient developing symptoms (acute disease) is rare so it is an unusual occurrence that brought this problem to the attention of the health district.
• On average, two cases of acute hepatitis C are reported each year in Clark County. Six cases have been identified in relation to this investigation.

How were patients exposed?

• A syringe (not a needle) that was used to administer medication to a patient was reused on the same patient to draw up additional medication.
• The process of redrawing medication using the same syringe could have contaminated the vial from which the medicine was drawn with the blood of the patient.
• The vial, which was not labeled for use on multiple patients, was then used for a second patient (with a clean needle and syringe).
• If that vial was contaminated with the blood of the first patient, any subsequent patients given medication from that vial could have been exposed to bloodborne pathogens.

Hepatitis C Investigation Graphic on How Patients were exposed

Download printer-friendly PDF of graphic

How did you determine the link between these cases?

• Of the six known cases, five had procedures on the same day. Genetic testing on four of the cases from that day has identified they likely came from a common source.
• The patient that had a procedure on a different day does not share a common source as the other four. This indicates the problem that allowed disease transmission to occur was not a one-time event, but had recurred over an extended period of time.
• Investigation of the clinic practices identified common practices, which would allow disease to be transmitted in this manner.

What actions have been taken to correct the unsafe injection control practices?

• The unsafe injection practices associated with these cases were identified during the investigation conducted in mid-January. The injection practices that lead to the exposure have been corrected, so no new patient exposures should be occurring.
• As it can take several months for the symptoms of hepatitis C to appear, additional cases might be identified despite no ongoing transmission of disease.

Who performed the investigation?

• The response was led by the Southern Nevada Health District, and the team included members of the Nevada State Bureau of Health Care Quality and Compliance and the Centers for Disease Control and Prevention.

Why is the health district also recommending testing for hepatitis B and HIV?

• The investigation revealed practices that could have exposed patients to the blood of another patient. Although hepatitis C was the focus of the investigation, hepatitis B and HIV can be transmitted in the same manner.

How many people will be diagnosed with hepatitis C, B or HIV from this investigation?

• It is unknown how many people were infected at the clinic. Hepatitis C, B and HIV are routinely found in the population. A significant number of people might have been infected prior to their procedure. Although testing can determine if a person is infected, it cannot determine the source of the infection.

How serious are these illnesses?

• Hepatitis C, B or HIV can result in a range of disease severity, and can eventually result in death.
• It is important that patients speak with a physician or health care provider if you have one of these diseases. A physician will be able to address specific risks for serious illness and develop a plan to monitor your health.

How many cases of hepatitis C are reported to the health district each year?

• On average, two cases of acute hepatitis C are identified each year in Clark County.
• Most people who become infected with hepatitis C initially have mild or no symptoms and do not know that they have been infected unless they are tested by a doctor. Only a small percentage of people infected with hepatitis C develop acute disease and have any outward signs of infection.

What is the Southern Nevada Health District’s role in the response?

• The Southern Nevada Health District is responsible for investigating reports of illness in our community in order to take steps to protect the health and well-being of the public.
• Once notified of a reportable disease the health district begins an investigation and works with the appropriate agencies to address any issues identified and make recommendations to help prevent this type of situation from occurring again.

As a patient how can I protect myself when getting these types of medical procedures?

• It is important to remember the transmission of the disease in these cases were not related to the medical procedures, but rather to the anesthesia administered to the patient.
• When proper injection practices are followed, medical procedures, including colonoscopies or similar procedures, are generally safe.
• All health care professionals and medical facilities should follow safe injection practices and infection control procedures. Patients can and should ask their medical providers about the practices used in their facility.

Are these types of medical procedures safe?

• Preventive medical procedures are an important part of protecting yourself against the development of diseases, including cancer. If recommended by your physician, there is no reason why you should avoid undergoing these types of medical procedures.
• Although this investigation focused on a center that performed endoscopies, the source of the exposure was the way the anesthesia was administered.

What is being done to prevent this from happening again?

• The Southern Nevada Health District, the Nevada State Health Division and the Bureau of Health Care Quality and Compliance are providing technical bulletins and educational materials to medical facilities and providers in an effort to educate the health care community and prevent these types of incidents from happening in the future.

What are the recommendations for people who test positive for hepatitis C, B or HIV?

• Options for disease management and possible treatment options, as well as regular health monitoring, should be discussed with a physician, who can determine the appropriate next steps for the patient.