New York City Department of Health investigating endoscopy clinic after hepatitis C outbreak

In June, the New York City Department of Health announced an investigation of a Brooklyn endoscopy clinic after eight people who underwent endoscopic procedures at the clinic were later diagnosed with hepatitis C. Seven of the people diagnosed with hepatitis C were hospitalized within a few weeks after their visits to the clinic, but all are currently at home recovering.

At press time, the New York City Health Department indicated that the "exact source of exposure" to hepatitis C is unknown and that it is conducting an "intensive investigation." The Bayridge Endoscopy and Digestive Health Center indicated that it would cooperate fully with the investigation.

In early May, a physician at the Bayridge Center notified the New York State Department of Health of hepatitis C symptoms among a group of patients who were seen at the clinic in late March. Subsequent tests by the New York City Department of Health confirmed hepatitis C in eight patients.

Investigators are reviewing medical charts and interviewing and testing all patients who received procedures during the last week of March. Blood specimens were forwarded to the Centers for Disease Control and Prevention for further testing in an attempt to determine the possible source of the outbreak. All medical procedures, equipment and supplies at the clinic are also being evaluated.

New York City Health Commissioner Neal L. Cohen, MD, says, "Transmission of hepatitis C in a medical setting is rare. Endoscopy is an important, routine medical procedure that is performed safely on thousands of New Yorkers every year." Dr. Cohen noted that the department has no evidence at this time of any other infections associated with the Bayridge clinic, but that laboratory evidence for hepatitis C infection may take up to six months to appear.

"The Clinical Practice Committee is monitoring the reports of the hepatitis C outbreak with interest and concern," says J. Sumner Bell, MD, Clinical Practice Committee Chair. "The mode of transmission in this case has not been precisely identified, but transmission of the hepatitis C virus via endoscopes has been implicated. Endoscopy is a safe procedure, and transmission of infections at the time of endoscopic procedures is exceedingly rare due to the care that is taken in cleansing of instruments when appropriate standards are followed."

The AGA recently adopted standards for office-based procedures that address environments like the Bayridge clinic. "Recently, market forces have introduced incentives for physicians to perform endoscopic procedures in office settings rather than in the more regulated GI facilities in hospitals and ambulatory surgical centers," says Dr. Bell. "The AGA’s office-based endoscopy standards (Gastroenterology, August 2001) were developed to promote patient safety in the office endoscopy setting."

The AGA asserts that patient safety is best protected if these standards are adopted by sites that also comply with state and federal laws for licensure, are certified as ambulatory surgery centers or are accredited by a nationally recognized accreditation program (e.g., the Joint Commission on Accreditation of Healthcare Organization’s new office-based surgery standards).

Up to now, no relevant practice standards for the performance of endoscopic procedures in these settings were available, a situation that the AGA believes puts patients at risk. The standards were developed to reduce that risk. The standards address 11 major topics from quality assurance to infection control and protection from pathogens. — Michael Roberts and Wendy Cohen