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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 26, Issue 2, Pages 77-84
http://dx.doi.org/10.1155/2015/160536
Original Article

Public Health Response to a Large-scale Endoscopy Infection Control Lapse in a Nonhospital Clinic

Jacqueline Willmore,1 Edward Ellis,2,3 Vera Etches,1,3 Lise Labrecque,1 Carla Osiowy,4,5 Anton Andonov,4,5 Cameron McDermaid,1 Anna Majury,6,7 Camille Achonu,8 Maurica Maher,9 Brenda MacLean,1 and Isra Levy1

1Ottawa Public Health, University of Ottawa, Ottawa, Ontario, Canada
2Public Health and Preventive Medicine Consultant, University of Ottawa, Ottawa, Ontario, Canada
3University of Ottawa, Ottawa, Ontario, Canada
4National Microbiology Laboratory, Public Health Agency of Canada, Canada
5University of Manitoba, Winnipeg, Manitoba, Canada
6Public Health Ontario, Queen’s University, Kingston, Canada
7Queen’s University, Kingston, Canada
8Public Health Ontario, Toronto, Canada
9Health Canada, Ottawa, Ontario, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To determine whether transmission of blood-borne pathogens (BBPs) (hepatitis B virus [HBV], hepatitis C virus [HCV] and HIV) occurred as a result of endoscopy reprocessing failures identified during an inspection of a nonhospital endoscopy clinic in 2011.

METHODS: The present analysis was a retrospective cohort study. Registered notification letters were mailed to 6992 patients who underwent endoscopy from 2002 to 2011 at one Canadian nonhospital endoscopy clinic, informing them of the infection control lapse and offering BBP testing. Multimedia communications and a telephone line supplemented notification. A retrospective study of patients with BBPs was performed with viral genetic testing and risk factor assessment for eligible patients. Risk for infection among patients whose procedure was within seven days of a known positive patient was compared with those whose procedure was performed more than seven days after a known postive patient. The seven-day period was selected as the period most likely to present a risk for transmission based on the documented cleaning procedures at the clinic and the available literature on virus survival.

RESULTS: Ninety-five percent (6628 of 6992) of patients/estates were contacted and 5042 of 6728 (75%) living patients completed BBP testing. Three were newly diagnosed with HBV and 14 with HCV. Twenty-three and 48 tested positive for previously known HBV or HCV, respectively, 367 were immune to HBV due to natural infection and one was immune to HBV due to immunization. None tested positive for HIV. Sequencing did not reveal any relationships among the 46 unique case patients with viral genetic test results available. Ninety-three percent of patients reported alternative risk factors for BBP. An increased risk for infection among those who underwent a procedure within seven days of a known HBV or HCV case was not demonstrated.

CONCLUSIONS: Endoscopy reprocessing failures were not associated with an increased risk for BBP among individuals tested.