Section 3: Establishing Communication Resources

Hepatitis C Outbreak, Southern Nevada, 2008

Note: this list assumes that all general inquiries about hepatitis C, hepatitis B, and HIV/AIDS are already covered in CDC-INFO prepared responses.
Questions are organized according to those pertaining to the general issue of Safe Injection Practices, the worried well, and CDC’s Role.

The Issue – Safe Injection Practices

What are Safe Injection Practices?

• Safe Injection Practices are a component of the basic infection control practices that all healthcare personnel should follow. Safe Injection Practices include appropriate practices related to the use of needles, syringes, and single and multidose medication vials.
• Definition of a safe injection: Safe injections are those that do not harm patients, do not expose healthcare providers to avoidable risks and do not result in waste that is dangerous to the community.
• Healthcare providers (doctors, nurses, and anyone providing injections) should never reuse a needle or syringe from one patient to another or to withdraw medicine from a vial. Both needle and syringe must be discarded once they have been used. It is not safe to change the needle and reuse the syringe – this practice can transmit disease.
• A multi-dose vial is a bottle of liquid medication that contains more than one dose of medication and is often used by diabetic patients or for vaccinations. A new, clean needle and clean syringe should always be used to access the medication in a multi-dose vial. Reuse of needles or syringes to access medication can result in contamination of the medicine with germs that can be spread to others when the medicine is used again.
• A complete list of the Safe Injection Practices recommendations can be found on the web at:
  http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
• A general fact sheet about syringe reuse can be found at: http://www.cdc.gov/injectionsafety/

What happened recently at the clinic in southern Nevada?

• In January 2008, CDC investigators responded to a request from the Southern Nevada Health District (SNHD) to help investigate three persons reported to the local surveillance program with acute hepatitis C virus (HCV) infection; all three persons had undergone procedures at a Las Vegas endoscopy clinic.
• Since beginning the investigation, CDC and SNHD have identified a total of six cases of HCV infection among patients who had undergone procedures at the clinic in the 35–90 days before developing symptoms. These patients did not have other risks for HCV infection (e.g., injecting drug use).
• For more information about the investigation in southern Nevada, please visit: http://www.southernnevadahealthdistrict.org/hepc-investigation/index.php.

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Worried Well

Does everyone who visits a healthcare provider or has some type of medical test have to be concerned about getting a serious infection?

• No, the risk for infection is low if appropriate infection control precautions are used. All healthcare providers and medical facilities should follow safe injection and appropriate infection control practices. Patients can and should ask their healthcare providers about the practices used in their facility.

I am scheduled to have a procedure at an ambulatory surgical center; is there anything I can do to learn about their safe injection practices?

• As a healthcare recipient, you have the right to ask any questions related to the procedure you are undergoing and the practices the surgical center uses to ensure your safety.
• You may want to find out the ambulatory surgery center’s procedures related to infection control and safe injections. These procedures include but are not limited to handwashing, needle and syringe use and disposal, use of equipment that is single-use or disposable, medication vial reuse, and prevention of medication contamination.

Are colonoscopies safe?

• When proper injection practices and infection control procedures are followed, medical procedures, including colonoscopies, are generally very safe.
• In the southern Nevada situation, the disease transmission was not related to the colonoscopy, but rather to the injection practices used to administer anesthesia to the patients.

Should I still get a colonoscopy?

• If recommended by your healthcare provider, there is no reason for you to avoid undergoing this procedure.
• Colonoscopies are an important way of screening for or detecting colorectal cancer.
• Although this investigation focused on a center that performed colonoscopies, and similar procedures, the source of the exposure was unsafe practices associated with administration of anesthesia and not the colonoscopy procedure.

As a patient, how can I protect myself?

• As a patient, you should feel empowered to discuss with your healthcare provider what steps are being taken to protect you.
• If you have concerns about specific issues, ask your healthcare provider about those issues.

If I think I may have been exposed, should I go to the emergency room?

• No. Although you are concerned about your health, this exposure is not immediately life threatening and does not require a visit to an emergency room.
• Emergency rooms should be used for immediate health emergencies only.
• Instead, please call your healthcare provider and make an appointment to get tested.

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CDC’s Role

Who performed the investigation at the Endoscopy Center of Southern Nevada?

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

Have other locations in Nevada been inspected to ensure that this is not occurring in other healthcare facilities?

• CDC, the Centers for Medicare and Medicaid Services, and the Southern Nevada Health District are assisting clinic inspectors to evaluate practices at about 50 other clinics in the region to ensure their practices are in line with standard infection control and safe injection practices.

What is CDC’s role in the inspection process in Nevada?

• CDC will assist the state health department to perform on-site visits at all their ambulatory surgery centers. This will include assessments of injection safety and other infection control procedures.
• CDC assistance includes sending a team of CDC personnel to provide on-site expertise and assistance in facility evaluation.
• CDC is in daily contact with Nevada’s state health department and other key officials. Regularly scheduled calls include CDC, state health officials, and the Southern Nevada Health District to share information and coordinate the activities of the investigation.
• CDC does not have regulatory authority to enforce recommended infection control practices.

What is happening in other clinics in the United States?

• There are currently no other investigations or reported concerns about safe injection practices or infection control in clinics across the country.
• CDC has previously investigated transmissions of hepatitis B and/or hepatitis C virus associated with unsafe injection practices or lapses in infection control in other clinics around the country. This is not the first or only time these practices have been discovered.

I am a reporter and would like to interview someone at CDC about this investigation. How do I get in touch with someone to interview?

• Contact CDC Media Relations at: (404) 639-3286.

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