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The virus hid inside a channel, carefully darting brushes, glutaraldehyde, and other enemies. It moved with gravitational force within the scope when it was hung to dry. It shifted slightly when other instruments were attached and the next procedure began.
After slyly avoiding detection, the pathogen slid off the instrument and into its perfect environment--the large intestine of an unsuspecting host. After several years of multiplying and infecting, the virus decides to make itself known. It makes its host nauseous, kills the appetite, and darkens the urine.
Hepatitis C (HCV) doesn't like to be discovered immediately after infection. Even though it sends some people to the hospital with acute symptoms within several weeks, it generally likes to hide in the bloodstream, planning its attack. Before the pathogen is uncovered, it has usually scarred the liver and caused irreparable damage. Those infected have a 10-30% risk of developing cirrhosis and a 3% risk of developing liver cancer.
The doctors try to pinpoint the infection. Have you ever used intravenous drugs? Have you ever had a blood transfusion or electrolysis? Do you have tattoos or do you use acupuncture? Are you sexually promiscuous?
Have you had an endoscopic procedure?
Although this last question is not generally on the list of HCV risk factors, endoscopic procedures can unwittingly transmit pathogens to patients. A recent HCV outbreak at an endoscopy center in Brooklyn has left the New York City Department of Health searching for the origin of infection. The clinic closed after seven people were admitted to local hospitals with acute symptoms of the bloodborne disease. After a closer inspection, another patient tested positive and it was released that 2,000 other patients underwent similar procedures since the clinic opened in January, 2000.
Within two days of the outbreak hitting the news, the city's Department of Health received more than 1,600 phone calls about testing options. Blood tests for the disease do not distinguish between chronic and recent infections and it may take up to six months for an infected person to test positive. Patients at the clinic also are being advised to be tested for hepatitis B and HIV.
Working in an endoscopy suite is difficult enough without having to worry about patients leaving with a new infection. However, the answer to this concern lies with you--the endoscopy team members.
It is crucial to endoscopy suites that each scope be handled and cleaned as though each patient were infected with HIV or hepatitis. It is also crucial that the staff at your suite be healthy. Officials in New York have yet to pinpoint the cause of this frightening outbreak, but their investigation includes testing the clinic's employees. Although there is not a vaccine for HCV, officials at the Centers for Disease Control and Prevention (CDC) recommend people be vaccinated for hepatitis A and B as a preventive measure. When was the last time you reviewed the methods of transmission of hepatitis and other diseases? Did you know that while the virus is not spread through breastfeeding or casual contact, according to a study from the University of Texas Southwestern Medical Center, people with a commercial tattoo are nine times more likely to have the disease?
At the Digestive Disease Week (DDW) conference this year in Atlanta, researchers discussed in depth the future of HCV and how to control the disease. A study presented showed the virus may more rapidly deteriorate the liver than previously thought. Mother-to-child transmission of the disease also is increasing, and patients with HIV are more likely to have HCV-induced liver disease than mono-infected patients.
There are enough dangerous sources of infection for HCV without placing endoscopy suites on the list. The time is now to take the extra effort to prohibit "endoscopic procedure" from being linked with other HCV risk factors.
Advancing your profession,
Kelli M. Donley, Editor
kdonley@vpico.com
(480) 990-1101 x.1593
P.S. This first issue comes from ideas and subjects we've received from local endoscopy team members. The future is in your hands. If there is something you are not seeing that you want, let me know. If there is a topic you need more information on, give me a call. If you want to feature a hard-working employee in our Endo All Stars, send me an email. Thanks for reading!
