器具使い回し肝炎 ５人感染１８人疑い 茅ケ崎市立病院
器具使い回し肝炎 ５人感染１８人疑い 茅ケ崎市立病院2007年12月26日06時32分 神奈川県にある茅ケ崎市立病院の循環器内科で心臓のカテーテル検査を受けた６０～７０代の男性患者５人が、Ｃ型肝炎に感染していたことがわかった。２５日、病院が記者会見して明らかにした。感染は昨年１２月から今年４月にかけてで、血圧変動を監視する器具「トランスデューサー」を交換せずに使い回したことが原因とみられる。メーカーの取り扱い説明書には１回ごとに廃棄するよう記載してある。使い回した理由について担当の臨床工学技士は「手術が立て込んでいて忙しかったから」と説明しているという。他に感染の疑いがある患者が１８人おり、病院は検査を受けるよう要請している。 病院側の説明によると、５人はいずれも病状に応じた治療を受けており、肝機能は改善しているという。 感染は今年１１月、同病院の消化器内科で肝炎と診断された２人が、同じ日に心臓カテーテル検査を受けていたことから発覚。調査の結果、昨年１２月の検査の際、すでにＣ型肝炎に感染していた患者から非感染者１人に、今年３月にも同じ感染者から別の非感染者１人に、さらに今年４月には３月に新たに感染した患者から別の非感染者３人に感染が広がったことが確認された。 病院側は、最初に感染源となった患者がＣ型肝炎患者だったことを把握していたという。 感染経路について、病院側はカテーテル検査で使われたトランスデューサーの可能性が強いとみている。出血を伴う可能性があるカテーテル検査では、患者の血圧チェックのためにトランスデューサーが使われるが、これが生理食塩水に満たされたチューブを介してカテーテルとつながっていることから、この使い回しによって肝炎感染者の血液が次々に非感染者と接したらしい。 同病院が今年１～１０月に行ったカテーテル検査は計２７６件あったが、１件ごとに使われるべきトランスデューサーは１７０個しか使われていなかった。 茅ケ崎市立病院は、病床数４０１、医師は約７０人おり、循環器内科など２３の診療科がある。 5 infected with hepatitis C after undergoing heart test12/27/2007BY KENZO MATSUMOTO, THE ASAHI SHIMBUNCHIGASAKI, Kanagawa Prefecture--A municipal hospital's practice here of reusing a disposable device for monitoring blood pressure during cardiac catheter tests resulted in five people developing hepatitis C. In a news conference at city hall here Tuesday, officials of Chigasaki Municipal Hospital disclosed details of this scandalous situation and apologized. They were joined by Chigasaki Mayor Nobuaki Hattori, who also apologized. The male patients in their 60s and 70s underwent the test at the hospital's cardiovascular internal medicine department between December 2006 and April. They apparently became infected because the blood monitoring transducer was used on multiple patients. The manual compiled by the instrument's manufacturer says it must be discarded after use, according to the hospital. But the in-house manual did not stipulate that a new transducer should be used for each test. A clinical engineering technician in charge of using the device cited a busy schedule for the tests for failing to adhere to the maker's manual, according to the hospital. The disposable transducer costs about 4,600 yen and is not covered by medical insurance. The hospital pays the cost. "We have taken all measures to cut off any route that may result in infection, such as making changes so that used and new instruments do not come in contact with each other and reviewing manuals," said Masashi Nakamura, who heads the cardiovascular internal medicine department. The hospital is calling on people who underwent cardiac catheter tests to be tested for hepatitis. Hospital officials suspect 18 others could have been infected. The five people in question developed acute hepatitis C and have been treated for their symptoms. Officials said their liver functions are improving. The hospital said it will cover the cost of any further treatment that may be necessary for the five. The infections surfaced after two patients were diagnosed with hepatitis at the hospital's gastroenterological internal medicine department in November. The hospital found that the two had undergone heart catheter tests on the same day. A hospital investigation revealed that a patient already infected with hepatitis C who underwent a heart catheter test last December, passed on the virus to a patient taking the same test. In March this year, the hepatitis carrier infected another individual who underwent the catheter test. Then in April, three people were infected by the patient who contracted hepatitis as a result of the March test. Officials admitted that the hospital knew from the outset that the patient who became the source of infections was a hepatitis C patient. The officials said the transducer used in the cardiac catheter tests was the likely catalyst in spreading the infection. The instrument is used to monitor blood pressure during catheter exams because of possible bleeding. The device is linked to the catheter via tubing filled with normal saline solution. Therefore, the reuse of the transducer likely resulted in blood from the hepatitis C patient infecting others in succession. A total of 276 catheter tests were conducted at the hospital January through October this year. But only 170 transducers were used instead of a new one for each patient. Nakamura, the head of the cardiovascular department, said he was shocked when he learned of the situation. "As a doctor, I thought the disposable devices were being discarded each time they were used," he said.(IHT/Asahi: December 27,2007)
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