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.
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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