PubMed · 10382414
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J Blakley, W Geels. Flexible endoscope reprocessing.. https://doi.org/10.1097/00001610-199903000-00006
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BACKGROUND: In early 1996 an outbreak of hepatitis B was detected among patients who attended an electroencephalogram (EEG) clinic in Toronto operated by a neurologist. In this article we report the results of an investigation conducted to determine the extent and source of the outbreak. METHODS: Notifications were sent to 18 567 patients who had attended any of 6 EEG clinics operated by the neurologist between 1990 and 1996 asking them to see their physician to be tested for hepatitis B virus (HBV) infection; 2957 envelopes were returned. Of the remaining 15 610 patients, results of laboratory tests were available for 10 244 (65.6%). A detailed follow-up of patients with newly acquired hepatitis B and those with chronic infection (carriers) was conducted. Viral DNA sequencing was used to compare strains of available HBV isolates. RESULTS: A total of 75 patients were identified in whom hepatitis B developed between 1991 and 1996; all of them had had at least one EEG performed in which reusable subdermal electrodes had been used. No cases were detected among patients who participated only in sleep studies, for which disk electrodes had been used. The peak rate of HBV infection (18.2 cases per 1000 person-EEGs) occurred in 1995. One technician performed all of the EEGs at the clinics and was found to be positive for hepatitis B e antigen. DNA sequencing confirmed that the virus isolated from the technician was identical to the virus isolated in 4 cases of hepatitis B tested. Infection control procedures were found to be inadequate. INTERPRETATION: The hepatitis B outbreak was a result of a common source of infection, the technologist, and inadequate infection control practices. Reusable subdermal EEG electrodes were the likely vehicles of transmission. Health care workers should follow recommended infection control practices and be vaccinated against hepatitis B.
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The authors, after defining basic concepts, make the case that nosocomial surveillance is an indispensable tool without which up-to-date infection control is impossible. They provide an overview of the nosocomial surveillance practices in many countries in Europe and overseas, comparing their methods, results and protocols, keeping in mind cost effectiveness and quality assurance considerations. The authors' view is that in Hungary two kinds of nosocomial surveillance programs should be established: 1. There should be reliable surveys to follow up the incidence of nosocomial infections. Without such data any national infection control strategy is at best uncertain. Obtaining this information is mostly in the interest of the government. Procedures should be coordinated from a central office, financial backing for the surveys should be provided, and the personal and institutional infrastructure should be built up in a consensual manner, with much care and technical expertise, relying on domestic and foreign experience. 2. Each institution should decide, based on their current goals, which selective nosocomial surveillance method is most appropriate for a given occasion. This decision should be voluntary and government regulation of these activities would be counterproductive.