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Isolation of HIV-1 from experimentally contaminated multidose local anaesthetic vials
J D Druce1, S A Locarnini, C J Birch
1Victorian Infectious Diseases Reference Laboratory, Fairfield Hospital, Melbourne.
Objective:
To investigate the hypothesis that HIV can be transmitted via contamination of multidose vials of local anaesthetic solution through reuse of needles and syringes.
Design And Setting:
Laboratory study. (1) By experiments with multidose vials and disposable needles and syringes, we identified a sequence of events in which HIV could contaminate the anaesthetic solution. (2) Three anaesthetic solutions were contaminated with a laboratory strain of HIV and tested by viral culture and p24 enzyme immunoassay one, two and four hours later to see how long the virus remained active.
Results:
(1) Needles and syringes retained small volumes of fluid after use (mean, 25 microL; in syringe alone, mean 16 microL) which could be transferred to multidose vials of local anaesthetic. (2) 10 mL of anaesthetic solution contaminated with 8 microL of HIV-infected solution (equivalent to 1% infected lymphocytes in vivo) contained active virus one hour later. In some settings, HIV could be isolated four hours after exposure.
Conclusion:
When inadvertently contaminated with HIV, multidose solutions represent a potential source of transmissible virus.
Insights
Reuse of needles and syringes can contaminate local anesthetic multidose vials with HIV. This contamination can lead to the transmission of the human immunodeficiency virus (HIV) through anesthetic solutions.
Area of Science:
- Virology
- Infectious Diseases
- Public Health
Background:
- Multidose vials of local anesthetics are used in various medical procedures.
- Concerns exist regarding potential transmission of infectious agents, including HIV, through contaminated medical supplies.
Purpose of the Study:
- To investigate the potential for HIV transmission via contamination of multidose local anesthetic vials.
- To determine if reuse of needles and syringes can lead to HIV contamination of anesthetic solutions.
Main Methods:
- Laboratory experiments simulating needle and syringe reuse with multidose anesthetic vials.
- Contamination of anesthetic solutions with a laboratory strain of HIV.
- Testing for active HIV in contaminated solutions at intervals of one, two, and four hours using viral culture and p24 enzyme immunoassay.
Main Results:
- Needles and syringes retained residual fluid (mean 25 microL) capable of transferring to multidose vials.
- HIV remained active in contaminated anesthetic solutions for up to four hours.
- A small volume of HIV-infected fluid (8 microL) could contaminate 10 mL of anesthetic solution, posing a transmission risk.
Conclusions:
- Inadvertent contamination of multidose anesthetic vials with HIV presents a significant risk for virus transmission.
- Safe injection practices, including the use of sterile, single-use needles and syringes, are crucial to prevent HIV transmission.
- Healthcare providers must adhere strictly to infection control protocols when handling multidose vials and injection equipment.