Perioperative Medicine  |   August 2019
Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada (J.M.v.V., M.J., S.B., R.P.); and the Departments of Microbiology and Immunology (J.M., N.G.T., S.M.S.) and Biochemistry (S.M.S.), McGill University, Montreal, Quebec, Canada.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • J.M.v.V. and J.M. contributed equally to this article.
    J.M.v.V. and J.M. contributed equally to this article.×
  • Submitted for publication August 20, 2018. Accepted for publication March 20, 2019.
    Submitted for publication August 20, 2018. Accepted for publication March 20, 2019.×
  • Address correspondence to Dr. Sagan: McGill University, 3655 Promenade Sir William Osler, Room 805B, Montreal, Quebec H3G 1Y6, Canada. selena.sagan@mcgill.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Basic Science / Infectious Disease / Technology / Equipment / Monitoring
Perioperative Medicine   |   August 2019
Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes
Anesthesiology 8 2019, Vol.131, 305-314. doi:https://doi.org/10.1097/ALN.0000000000002772
Anesthesiology 8 2019, Vol.131, 305-314. doi:https://doi.org/10.1097/ALN.0000000000002772
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Health care–acquired hepatitis C virus infection continues to occur

  • Current guidelines caution against using multidose vials for more than one patient unless the vials are kept in a location away from the patient treatment area

  • It is possible that in some circumstances these guidelines are not always followed

What This Article Tells Us That Is New:

  • When a medication vial diaphragm is contaminated with hepatitis C virus, the contents of the vial can become contaminated with subsequent access with a clean syringe, and the viral content is sufficient to infect cells in culture

  • Hepatitis C virus remains infectious in contaminated medications for several days

  • Cleaning the vial surface with 70% isopropyl alcohol does not eliminate the risk of vial contamination with hepatitis C virus

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.