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Anesthesiology. 2019 Aug;131(2):305-314. doi: 10.1097/ALN.0000000000002772.

Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes.

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From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada (J.M.v.V., M.J., S.B., R.P.) the Departments of Microbiology and Immunology (J.M., N.G.T., S.M.S.) Biochemistry (S.M.S.), McGill University, Montreal, Quebec, Canada.



Health care-acquired hepatitis C virus infection continues to occurCurrent guidelines caution against using multidose vials for more than one patient unless the vials are kept in a location away from the patient treatment areaIt is possible that in some circumstances these guidelines are not always followed WHAT THIS ARTICLE TELLS US THAT IS NEW: When a medication vial diaphragm is contaminated with hepatitis C virus, the contents of the vial can become contaminated with subsequent access with a clean syringe, and the viral content is sufficient to infect cells in cultureHepatitis C virus remains infectious in contaminated medications for several daysCleaning the vial surface with 70% isopropyl alcohol does not eliminate the risk of vial contamination with hepatitis C virus BACKGROUND:: Health care-associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus-infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients.


A parallel-arm lab study (n = 9) was performed in which contamination of medication vials in healthcare settings was simulated using cell culture-derived hepatitis C virus. First, surface-contaminated vials were accessed with sterile needles and syringes, and then hepatitis C virus contamination was assessed in cell culture. Second, after contaminating several medications with hepatitis C virus, viral infectivity over time was assessed. Last, surface-contaminated vial diaphragms were disinfected with 70% isopropyl alcohol to determine whether disinfection of the vial surface was sufficient to eliminate hepatitis C virus infectivity.


Contamination of medication vials with hepatitis C virus and subsequent access with sterile needles and syringes resulted in contamination of the vial contents in sufficient quantities to initiate an infection in cell culture. Hepatitis C virus remained viable for several days in several commonly used medications. Finally, a single or 2- to 3-s wipe of the vial diaphragm with 70% isopropyl alcohol was not sufficient to eliminate hepatitis C virus infectivity.


Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.

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