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Population Risk of Syringe Reuse: Estimating the Probability of Transmitting Bloodborne Disease

Published online by Cambridge University Press:  02 January 2015

Christopher Sikora ,
A. Uma Chandran ,
A. Mark Joffe ,
David Johnson  and
Marcia Johnson
Christopher Sikora*
Affiliation:
University of Alberta, Edmonton, Canada
A. Uma Chandran
Affiliation:
University of Alberta, Edmonton, Canada Alberta Health Services, Edmonton, Canada
A. Mark Joffe
Affiliation:
University of Alberta, Edmonton, Canada Alberta Health Services, Edmonton, Canada
David Johnson
Affiliation:
Alberta Health Services, Edmonton, Canada
Marcia Johnson
Affiliation:
Alberta Health Services, Edmonton, Canada
*
Community Medicine Residency Program, School of Public Health, University of Alberta, Main Fl, West Tower 101, 14310-111 Ave, Edmonton, AB T5M 3Z7, Canada (csikora@ualberta.ca)
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Extract

Background.

In 2008, the Medical Officer of Health at Alberta Health Services (Edmonton, Canada) was notified that, in some practice settings, a syringe was used to administer medication through the side port of an intravenous circuit and then the syringe, with residual drug, was used to administer medication to other patients in the same manner. This practice has been implicated in several outbreaks of bloodborne infection in hospital and clinic settings.

Methods.

A risk assessment model was developed to predict the risk of a patient contracting a bloodborne viral infection from the practice. The risk of transmission was defined as the product of 5 factors: (1) the population prevalence of a specific bloodborne pathogen, (2) the probability of finding a viral bloodborne pathogen in an intravenous circuit, (3) the rate of syringe reuse, (4) the probability of causing disease given a bloodborne pathogen exposure, and (5) the susceptibility of the exposed person.

Results.

The risk was modeled first with consistent use of the proximal port of the intravenous circuit. The risk of transmission of hepatitis B virus was approximately 12–53 transmission events per 1,000,000 exposure events for a range of practice probabilities (ie, frequency of the risk practice) from 20% to 80%, respectively. The risk of transmission of hepatitis C virus was approximately 1.0–4.3 transmission events per 1,000,000 exposure events for the same practice probability range, and the risk of transmission of human immunodeficiency virus was approximately 0.03–0.15 transmission events per 1,000,000 exposure events for the same practice probability range. The use of the distal port was associated with a 10-fold decrease in the risk.

Conclusions.

Practitioners must practice safe, aseptic injection techniques. The model presented here can be used to estimate the risk of disease transmission in situations where reuse has occurred and can serve as a framework for informing public health action.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 7 , July 2010 , pp. 748 - 754
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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