Reuse of Insulin Pens Among Multiple Patients at 2 Veterans Affairs Medical Centers

2015 ◽  
Vol 36 (10) ◽  
pp. 1121-1129
Author(s):  
Patricia Schirmer ◽  
Carla A. Winston ◽  
Cynthia Lucero-Obusan ◽  
Mark Winters ◽  
Alan Lesse ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis B Virus ◽  
Veterans Affairs ◽  
Medical Centers ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Strain Testing ◽  
Veterans Affairs Medical Centers ◽  
Insulin Pens ◽  
Multiple Patients

OBJECTIVETo determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP).DESIGNRetrospective cohort study.SETTINGTwo Veterans Affairs medical centers.PATIENTSVeterans who received insulin via insulin pens from 2010 to 2013.METHODSPatients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing.RESULTSOf 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness.CONCLUSIONSOur investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.Infect Control Hosp Epidemiol 2015;36(10):1121–1129

scholarly journals Algorithms for the Testing of Tissue Donors for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus

2020 ◽  
pp. 1-10
Author(s):  
Axel Pruß ◽  
Akila Chandrasekar ◽  
Jacinto Sánchez-Ibáñez ◽  
Sophie Lucas-Samuel ◽  
Ulrich Kalus ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Tissue Donors ◽  
Occult Hbv Infection ◽  
Occult Hbv ◽  
B Virus ◽  
Immunodeficiency Virus

<b><i>Background:</i></b> Although transmission of pathogenic viruses through human tissue grafts is rare, it is still one of the most serious dreaded risks of transplantation. Therefore, in addition to the detailed medical and social history, a comprehensive serologic and molecular screening of the tissue donors for relevant viral markers for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) is necessary. In the case of reactive results in particular, clear decisions regarding follow-up testing and the criteria for tissue release must be made. <b><i>Methods:</i></b> Based on the clinical relevance of the specific virus markers, the sensitivity of the serological and molecular biological methods used and the application of inactivation methods, algorithms for tissue release are suggested. <b><i>Results:</i></b> Compliance with the preanalytical requirements and assessment of a possible hemodilution are mandatory requirements before testing the blood samples. While HIV testing follows defined algorithms, the procedures for HBV and HCV diagnostics are under discussion. Screening and decisions for HBV are often not as simple, e.g., due to cases of occult HBV infection, false-positive anti-HBc results, or early window period positive HBV NAT results. In the case of HCV diagnostics, modern therapies with direct-acting antivirals, which are often associated with successful treatment of the infection, should be included in the decision. <b><i>Conclusion:</i></b> In HBV and HCV testing, a high-sensitivity virus genome test should play a central role in diagnostics, especially in the case of equivocal serology, and it should be the basis for the decision to release the tissue. The proposed test algorithms and decisions are also based on current European recommendations and standards for safety and quality assurance in tissue and cell banking.

Results from a Large-Scale Epidemiologic Look-Back Investigation of Improperly Reprocessed Endoscopy Equipment

2012 ◽  
Vol 33 (07) ◽  
pp. 649-656 ◽  
Author(s):  
Mark Holodniy ◽  
Gina Oda ◽  
Patricia L. Schirmer ◽  
Cynthia A. Lucero ◽  
Yury E. Khudyakov ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Large Scale ◽  
Bloodborne Pathogens ◽  
Medical Centers ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Viral Testing ◽  
Veterans Affairs Medical Centers ◽  
High Level ◽  
Nose And Throat

Objective.To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.Design.Retrospective cohort study.Setting.Four Veterans Affairs medical centers (VAMCs).Patients.Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.Methods.Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.Results.Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.Conclusions.Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

New Technique for the Sterile Introduction of Flexible Nasopharyngolaryngoscopes

1993 ◽  
Vol 102 (9) ◽  
pp. 687-689 ◽  
Author(s):  
Harvey D. Silberman ◽  
Avraham Hampel ◽  
Alan H. Kominsky
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Thermoplastic Elastomer ◽  
New Technique ◽  
Virus Hepatitis ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Reducing Costs ◽  
A New Technique

Since the inception of flexible fiberoptic endoscopes, disinfection of these instruments has been a problem. Soaking in glutaraldehyde does not always achieve sterilization, and often damages the scopes. Ethylene oxide can sterilize endoscopes; however, it is economically impractical because of a required downtime of 24 hours. Thus, it is obvious, especially with respect to human immunodeficiency virus, hepatitis B virus, and Mycobacterium, that a new technique to attain sterility is necessary. This paper discusses a new method of sterile introduction of the flexible nasopharyngolaryngoscope. The technique employs disposable sterile sheaths that are prepackaged and made from a thermoplastic elastomer with a clear optical end. The sheaths can be applied in seconds and tightly adhere to the flexible insertion portion of the scope. Results to date indicate that the performance of the endoscope is unhindered by using the sheaths. Furthermore, there has been no break in the integrity of the sheaths or damage to instruments. It is our opinion that these devices will greatly improve the level of sterility while at the same time reducing costs and downtime.

scholarly journals Synthesis of 4′-Substituted Purine 2′-Deoxynucleosides and Their Activity against Human Immunodeficiency Virus Type 1 and Hepatitis B Virus

2018 ◽  
Vol 3 (11) ◽  
pp. 3313-3317 ◽  
Author(s):  
Satoru Kohgo ◽  
Shuhei Imoto ◽  
Ryoh Tokuda ◽  
Yuki Takamatsu ◽  
Nobuyo Higashi-Kuwata ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Human Immunodeficiency Virus Type ◽  
Virus Type ◽  
B Virus ◽  
Immunodeficiency Virus

scholarly journals Spectrum of Liver Disease in Hepatitis B Virus (HBV) Patients Co-infected with Human Immunodeficiency Virus (HIV): Results of the HBV-HIV Cohort Study

2019 ◽  
Vol 114 (5) ◽  
pp. 746-757 ◽  
Author(s):  
Richard K. Sterling ◽  
Abdus S. Wahed ◽  
Wendy C. King ◽  
David E. Kleiner ◽  
Mandana Khalili ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Liver Disease ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
B Virus ◽  
Immunodeficiency Virus
Sign in / Sign up

Export Citation Format

Share Document