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Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes
Janet M van Vlymen1, Julie Magnus, Melanie Jaeger
1From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada (J.M.v.V., M.J., S.B., R.P.) the Departments of Microbiology and Immunology (J.M., N.G.T., S.M.S.) Biochemistry (S.M.S.), McGill University, Montreal, Quebec, Canada.
Background:
Health care-associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus-infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients.
Methods:
A parallel-arm lab study (n = 9) was performed in which contamination of medication vials in healthcare settings was simulated using cell culture-derived hepatitis C virus. First, surface-contaminated vials were accessed with sterile needles and syringes, and then hepatitis C virus contamination was assessed in cell culture. Second, after contaminating several medications with hepatitis C virus, viral infectivity over time was assessed. Last, surface-contaminated vial diaphragms were disinfected with 70% isopropyl alcohol to determine whether disinfection of the vial surface was sufficient to eliminate hepatitis C virus infectivity.
Results:
Contamination of medication vials with hepatitis C virus and subsequent access with sterile needles and syringes resulted in contamination of the vial contents in sufficient quantities to initiate an infection in cell culture. Hepatitis C virus remained viable for several days in several commonly used medications. Finally, a single or 2- to 3-s wipe of the vial diaphragm with 70% isopropyl alcohol was not sufficient to eliminate hepatitis C virus infectivity.
Conclusions:
Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.
Insights
Hepatitis C virus (HCV) can contaminate medications through vial access, remaining viable for days. Standard alcohol disinfection of vial tops is insufficient to prevent HCV transmission, posing risks in healthcare settings.
Area of Science:
- Infectious Diseases
- Virology
- Healthcare Epidemiology
Background:
- Hepatitis C virus (HCV) outbreaks linked to contaminated medication vials persist.
- Practitioners often deny reusing needles/syringes, suggesting indirect contamination routes.
- Hypothesis: Healthcare providers may inadvertently contaminate vial diaphragms, transferring HCV into medication.
Purpose of the Study:
- To investigate HCV transfer from contaminated vials into medication.
- To assess HCV viability in medications after vial access.
- To evaluate the efficacy of 70% isopropyl alcohol disinfection on vial diaphragms.
Main Methods:
- Simulated contamination of medication vials with cell culture-derived HCV.
- Accessed contaminated vials with sterile needles/syringes, assessing HCV in contents.
- Assessed HCV infectivity over time in various medications.
- Tested disinfection effectiveness of vial diaphragms with 70% isopropyl alcohol.
Main Results:
- HCV transfer into vial contents occurred via sterile needles/syringes, sufficient for infection.
- HCV remained viable for several days in common medications.
- Single/brief (2-3s) 70% isopropyl alcohol wipes were insufficient to eliminate HCV infectivity.
Conclusions:
- HCV can be transferred into medications and remain viable for days.
- Standard vial diaphragm disinfection with 70% isopropyl alcohol is inadequate.
- Highlights risks of medication sharing and potential for nosocomial HCV transmission.
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