Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
Hepatitis B or C: How to Avoid Infection During a Procedure
Posted in Hepatitis B by Dr. Sharon Orrange on May 17, 2013
Imagine you receive a letter from the doctor or facility where you’ve had a procedure, and this letter tells you there is a chance you were exposed to Hepatitis B or C. While these stories are rare, they do happen. Patients have been infected with Hepatitis C after endoscopy, colonoscopy, and epidural injections.

Before we panic, know that transmission of Hepatitis C is incredibly rare after GI endoscopy procedures, with an estimated frequency of 1 in 1.8 million procedures. Here is what you need to watch out for during a procedure to ensure your risk of infection with a blood-borne illness like Hepatitis C is zilch.

Why a risk of Hepatitis C during endoscopy or colonoscopy? Given the delicate structure of the flexible equipment used, it cannot be autoclaved for sterilization the way we autoclave surgical tools. This means there is a process of mechanical cleaning followed by high-level disinfection, rinsing, drying, and storage. Stringent guidelines exist here, and they were not followed in the recent cases reported in Atlanta. You can ask the nurses at the Endoscopy suite or your doctor for reassurance that they follow these. Let them know you know what they are supposed to be doing.

What you don’t know. Many of these Hepatitis C infections are not from the actual procedure or equipment but from the injection of numbing or calming medication, especially lidocaine. Re-using syringes (yuck) and use of contaminated multiple-dose drug vials was responsible for a Hepatitis outbreak in California in patients receiving epidural injections. What you need to look for is that the lidocaine bottle is a SINGLE use vial (the doctor will break off the glass top for use during your injection) and not a large vial they are using to “draw up” the lidocaine and then re-using for another patient. Single-use drug vials are recommended and should be used by everyone. Period.

Hepatitis B: While we may not be able to protect you from the rare patient–to-patient transmission, there are mandates that say all health care employees should be immunized against Hepatitis B. This is basic and you can ask about this.

Now, back to the endoscopy suite. Take a good look around and make sure general infection control principles are being followed. Hand washing needs to happen before and after each patient interaction and each endoscopy procedure, irrespective of whether gloves are used. Be aware that there is separation of soiled and clean tasks and handling of specimens, tissues, soiled linens, and contaminated wastes. You’ll see those red trash cans (toxic waste) apart from the regular white ones so while you are waiting for your procedure make sure the employees are using them correctly.

Risk of transmission of Hepatitis C and B during colonoscopy is rare but be a watchdog and lower your chance to zero.

- Dr. O


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CONDITIONS AND COMMUNITIES: Colon Cancer  •  Hepatitis B  •  Hepatitis C

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I just wish the government would start caring about prevention from the get-go instead of getting caught up in debates regarding cost of treatment when there is already an epidemic. It is much more cost effective to make sanitization a priority to prevent the spread of viruses. There are products out there like SaniGuard sold by ER Distributing that can kill these viruses on contact. Unfortunately, prevention doesn't put money into the pockets of the big pharmaceutical companies
By rogerwax  Feb 05, 2014
Rebetol is use to cure Hepatitis C...
By Aroinda  May 30, 2013
I'm trying hard to not be alarmed as my hubby just had a colonoscopy and now they wanted him to be vaccinated for hep A&B plus have a TB test?? He said the "operating room" looked like an office tho he was at a major provider's facility??
By calady50  May 19, 2013
You left out the HIV risks.
Is this practice even offering to pay for testing due to this inexcusable and undocumented risk to life?
How about treatment being paid by these do tors who clearly did a lousy xsupervisory role to ensure patients were not exposed to unnecessary risk.

How many pa
By SunnyBunn  May 19, 2013
And really.... once a patient is in the suite they are responsible for paying the bill..
Doctors have the deck stacked against us with all their rules and regulations about how they get paid....
this is just another example of the money making proposition that medicine has become when patient care goes down so badly that deaths and life threatening infections are allowed to go on during procedures that should be safe....
where is the justice????
By SunnyBunn  May 18, 2013
These doctors should be libel for injuries such as these during routine procedures!
Why is it that doctors are the ONLY professionals who can cause serious injury like this without any consequences?
There simply is NO excuse for killing someone because of a cancer screening. How does it make any sense to end up with Hep C because "we want to be sure to nip colon cancer in the bud"?
By SunnyBunn  May 18, 2013
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