Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies.

CONTEXT: Nuclear pharmacies prepare radiopharmaceutical products for use in common diagnostic procedures, including myocardial perfusion studies. Hepatitis C virus (HCV) transmission has not been reported previously in the setting of nuclear imaging studies. OBJECTIVE: To investigate an outbreak of acute HCV infection identified among patients who underwent myocardial perfusion studies on October 15, 2004, using an injected radiopharmaceutical. DESIGN, SETTING, AND PATIENTS: Outbreak investigation including molecular epidemiology and pharmacy site investigation at outpatient cardiology clinics and a nuclear pharmacy in Maryland. Ninety patients who received injections drawn from select radiopharmaceutical vials prepared on October 14-15, 2004, at a single nuclear pharmacy were offered testing for bloodborne pathogens. Pharmacy procedures were reviewed and HCV quasi species analysis was performed. MAIN OUTCOME MEASURES: Hepatitis C virus infection and quasispecies sequence similarity. RESULTS: Sixteen patients with acute HCV infection were identified from 3 separate clinics. All patients received radiopharmaceutical injections drawn from a single pharmacy vial (vial 1). None of the 59 tested patients who received doses from 6 other vials had acute HCV infection. Blood from a potential source patient with HCV and human immunodeficiency virus (HIV) infection was processed for a radiolabeled white blood cell study in the pharmacy 12 hours before vial 1 was prepared. The HCV quasispecies sequences from this potential source patient were nearly identical to those from cases (97.8%-98.5% similarity). No acute HIV infections were identified. Pharmacy practices that could have led to blood cross-contamination included reuse of needles and syringes during dilutions and use of common flow hoods for some steps in the preparation of sterile and blood-derived products. CONCLUSIONS: Sixteen persons acquired HCV infection from a blood-contaminated radiopharmaceutical. The source and practices that could have facilitated breaks in aseptic technique were identified at the pharmacy. Nuclear pharmacies that handle biological products should follow appropriate aseptic technique to prevent contamination of sterile radiopharmaceuticals.

Infection control program disparities between acute and long-term care facilities in Maryland.

BACKGROUND: In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute care hospitals (ACHs), long-term care facilities (LTCFs), and specialty hospital (acute rehabilitation and behavioral health) facilities in the state to determine the current state of infection control resources and practices in Maryland. Federal health care facilities in Maryland were not surveyed. METHODS: A self-administered questionnaire was sent to all 40 ACHs, 247 LTCFs, and 20 specialty hospitals in the state. The senior infection control professional (ICP) in the facility completed the questionnaire. RESULTS: The response rates were 85% for ACHs, 39% for LTCFs, and 95% for specialty hospitals. Data were analyzed separately for each type of facility. The ICPs in acute care reported 1.2 full-time equivalent positions (FTEs) for each 200 acute care beds, whereas ICPs in LTCFs reported 0.3 FTEs per 200 LTCF beds. Ninety percent of acute care ICPs reported taking some type of basic infection control course, whereas only 3% of long-term care ICPs reported taking a basic infection control course. CONCLUSION: In this survey of ICPs in Maryland, striking differences were noted between ACHs and LTCFs in the ratio of ICP FTEs to beds and in basic infection control educational preparation for ICPs. These findings suggest that Maryland LTCFs could benefit from basic infection control training and from regulatory actions addressing staff-to-resident ratios.

Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore.

We examined the epidemiology of invasive penicillin-resistant Streptococcus pneumoniae (PRSP) infections among residents of the Baltimore metropolitan area from 1995 through 1997. During this period, the proportion PRSP cases increased 42%, from 5.7% to 8.1% of cases. PRSP rates were highest among persons aged <5 and > or =65 years, black patients, and urban dwellers. However, the proportion of PRSP cases was higher among white persons (10%) than it was among black persons (5%) and among residents of suburban counties (10%) versus urban counties (6%). PRSP cases were more common in November-April (8%) than they were in May-October (5%), particularly for persons aged > or =65 years (10% vs. 1%). By use of logistic regression, white race, suburban residence, and winter respiratory season were found to be independent predictors of infection with PRSP. The incidence of PRSP is increasing in Baltimore, and the seasonality of PRSP suggests that recent antibiotic use, which is more common in winter months, may rapidly affect the prevalence of resistant pneumococcal infections.