An outbreak of non-A, non-B hepatitis associated with the infusion of a commercial factor IX complex during cardiovascular surgery

Hospital-acquired infections related to contaminated substances

Drug-related outbreaks are frequently reported from various medical departments. A systematic review was performed to describe characteristics of these outbreaks and to determine the most frequent occasions in which contamination of substances for patient care take place. Articles were assessed by a search of the outbreak database, a search of PubMed, and hand search of reference lists from relevant articles. Articles published before 1990 were excluded. Data on affected patients, hospital-acquired infections, substances, pathogens and graded information about the location of the contamination incidence were extracted. A total of 2250 patients in 128 articles were included, mostly from intensive care units or haematological departments. Septicaemia was the most frequent hospital-acquired infection. Most often articles report contamination of blood products and heparin-sodium chloride solutions. The most frequent pathogens were hepatitis A virus, Yersinia enterocolitica, and Serratia spp. for blood products and Burkholderia cepacia and Enterobacter spp. for substances other than blood products. Mortality was highest if red blood cells or total parenteral nutrition formulas were contaminated. In 64 of the outbreaks multi-dose vials had been used against the manufacturers' recommendations. Thus, drug-related outbreaks are likely to occur particularly when basic hygiene measures are disobeyed. A large proportion of drug-related nosocomial infections could have been prevented, for example, by avoiding the use of multi-dose vials.

Safety of virus inactivated antithrombin III concentrate antithrombin III immuno (AT III)

In a prospective clinical trial the risk of infection after application of virus inactivated antithrombin III concentrate ANTITHROMBIN III IMMUNO (AT III) was investigated in patients undergoing cardiovascular surgery. The study was conducted according to the recommendations of the International Committee on Thrombosis and Hemostasis (ICTH), with the exception that most patients required additional blood products as well as AT III. Twenty-seven patients were eligible to test for the risk of acquiring hepatitis B. Twenty-six patients could be evaluated in terms of hepatitis NANB transmission considering ALT-levels whereas 20 patients could be tested for anti-HCV one year after surgery. Samples from 78 patients could be monitored for anti-HIV-1. None of these patients showed any signs of infection. AT III IMMUNO seems to be an antithrombin III concentrate with low or absent infectivity.

Safety of vapour heated prothrombin complex concentrate (PCC) Prothromplex S-TIM 4

The risk of infection after application of vapour heated prothrombin complex concentrate PROTHROMPLEX S-TIM 4 (PCC) was investigated in patients undergoing cardiovascular surgery. The study was conducted according to the recommendations of the International Committee on Thrombosis and Hemostasis (ICTH) with the exception that most patients required other blood products in addition to PCC. Twenty-One patients were eligible to test for the risk of acquiring hepatitis NANB (ALT-levels) and samples from 12 patients were available that could be screened for anti-HCV. Twenty patients qualified for evaluation of the risk of developing hepatitis B, and 67 patients qualified to test for HIV-1-Infection. None of these patients showed any signs of infection. Vapour heating of prothrombin complex concentrate seems to lower the risk of transmitting viral diseases considerably.