Investigation of potential iatrogenic transmission of hepatitis C in Victoria, Australia

Objective: To determine the level ct exposure to medical and surgical proce dures among Australian-born patients whose mode of acquisition of the hepat itis C virus (HCV) is unknown. Method: Place and time of study: Melbourne, Australia, 1998-2000. Design: Retrospective case series. Instrument Structured questionnaire admi nistered by one interviewer. Setting: Referral centre for hepatitis C in a tertiary teaching hospital. Participants: Australian-born individuals persistently HCV antibody (anti-H CV) positive on at least two second-generation commercial assays. Main outc ome measures. Demographic and self-reported exposure data. Results: Of 135 anti-HCV positive individuals with no known mode of transmi ssion, 54 (40%) individuals fulfilled all the entry criteria and agreed to participate. Of the 54 cases, 53 had at least one medical/surgical procedur e and/or invasive dental work; 46 (85%) had dental extractions, 19 (35.2%) had complex dental work, e.g. root canal, 44 (82%) had an operation requiri ng general anaesthesia, 41 (75.9%) had a procedure requiring local anaesthe tic, and a number of endosropic procedures were reported: gastroscopy (n=3) , colonoscopy (n=3), laparoscopy (n=4), arthroscopy (n=5), cystoscopy (n=2) . Conclusion: We have documented exposure to medical/surgical procedures amon g HCV patients with no previously recognised mode of transmission. Implications: The findings of this study have important public health impli cations for current cleaning, disinfection and sterilisation procedures and protocols (or lack of these) as well as for the policies and guidelines re lating to the re-use of medical equipment such as multi-dose vials, suturin g material and anaesthetic circuits.