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From: "Steve Harris" <>
Subject: Re: Lubrication of vaginal introitus & external speculum / cause 
	for cross-contamination?
Date: Tue, 3 Dec 2002 20:06:58 -0700
Message-ID: <asjrcn$ent$>

"yelxol" <> wrote in message
> "Richard Cavell" <> wrote in message
> > "yelxol" <> wrote in message
> >
> >
> > > Here is just one of the reports I have located: (there are others)
> >
> > Hang on, you said cross-contamination.  This is primary contamination
> > from a source outside the institution.
> Here you go, Richard:
> "Transmission was by administration of propofol from
> multi-dose vials"
> J. Clin. Microbiol. 2001; 39: 2860-3
> 31 July 2001
> Hepatitis C outbreak among gynecology patients
> Italian doctors have investigated an outbreak of
> hepatitis C infection among gynecological patients
> undergoing surgery at the same clinic.
> Dr Marco Massari and colleagues used molecular
> fingerprinting analysis and epidemiological techniques
> to examine 4 recent cases of hepatitis C infection in
> patients at the same gynecology clinic.
> Dr Massari identified the possible source of the
> infection as an HCV-positive woman, who was the first
> patient of a surgical session that also included the
> four other women involved in the outbreak.
> All 5 patients were infected with hepatitis C virus
> type 1b.
> Molecular characterization of HCV isolates in each
> patient revealed a close homology between the viral
> isolates of the suggested source of the infection and
> those from the outbreak patients.
> Molecular characterization was achieved by sequence
> analysis of structural envelope regions and the
> nonstructural NS5 region of the viral genome.
> Dr Massari's team also compared the viral isolates of
> the source with those from 4 unrelated cases of
> hepatitis C type 1b in the same area (controls).
> Transmission was by administration of propofol from
> multi-dose vials
> Journal of Clinical Microbiology
> The controls were significantly less similar to the
> viral isolates of the source patient then isolates
> from the outbreak patients.
> The investigation of the outbreak revealed that the
> virus was transmitted by administration of propofol
> from multi-dose vials.

Which is weird in and of itself, since I didn't think Propofol even came in
multi-dose vials anymore. As you may know, the stuff comes dissolved in a
lipid emulsion which looks for all the world like Interlipid (IV fat
emulsion for hyperalimentation). It's perfect for growing bugs (meaning
bacteria) in, and that's the reason why I thought it had all long ago gone
to single use glass ampules. Tell me it's not so. Was this in some country
outside the US?

Steve Harris
You can email me at
But remove the numerals in the address first.


Our nada who art in Nada
Nada be thy nada..

            -- Dada Hemingway

From: "Steve Harris" <>
Subject: Propofol and Italians (wups, wops) was Re: Lubrication of vaginal 
	introitus & external speculum / cause for cross-contamination?
Date: Wed, 4 Dec 2002 00:15:56 -0700
Message-ID: <ask9vd$bul$>

"PF Riley" <> wrote in message
> I think that Dr. Marco Massari and his team of Italian doctors would
> be outside the U.S., yes.

Well, how would I know? Maybe they're all from Manhattan (presumably East of
SoHo, between Houston and Canal...)

Anyway, yes, I went to read the article, and it is/was indeed a big Italian
fiasco (La Grande Fuccupo). What happened is that 5 women done at this
Italian GYN surgical clinic one morning in early 1998 all got contaminated
from the first patient of the day, who was (already) known to be chronic hep
C pos. The geniuses were using multidose vials of fentenyl and propofol in
the surgery. The women who got infected with same strain that morning,
shared only the propofol. This could not have happened in the US, since
propofol started causing peri-surgical iatrogenic infections was reported as
early as 1990, due to the fact that it can't be packaged as a properly
bacteriostatic preparation (they've since added EDTA to it, but it still
can't be USP bacteriostatic packaged). There was a big stink in the NEJM in
1995 about this, with a bunch of patients getting infected, and after that
the FDA made the manufacturer in the US (at least) go entirely to
single-patient single-use packaging for this drug, since no way could the
multidose vial be safe, even with proper procedure followed. Even for single
patients the prep has to be tossed 12 hours after spiking it, since bugs can
grow significantly even after 6 hours.

Now, the Italian study states they were still using "multidose" propofol
vials, when the cross contamination happened, one specific day in Jan 1998.
I don't know if they were using a single-patient vial multiple times, or if
the corrupt manufacturer simply continued selling Italians multidose vials
for 3 years after it had been made painfully clear that they were unsafe in
any conditions, in the world medical literature, and several years after
being outlawed in the US. But whatever the case, this Italian clinic kept
using the stuff.

> What I'd like to know is, still, how in the hell did the HCV get into
> the multi-dose vials of propofol? Didn't they at least stick a new,
> fresh, sterile needle and syringe into the container and draw out what
> they needed each time?

They said they did, but obviously didn't. The infection team surmised that
somebody had used the same needle to give the first dose into the IV port
(getting contaminated by blood reflux up the IV line during a BP check or
something), and then stuck that same needle at least once back into the
"multidose" container to get another dose (perhaps even for the same
patient-- doesn't matter). From that point, however, the game was up for the
other patients. It could as easily have been a multidose fentenyl or other
container from the viewpoint of poor technique, except that there must be
something friendly to hep C in the propofol emulsion, which, as noted, is a
very odd vehicle. The virus obviously can't grow there or multiply there,
but just as obviously it must be an okay place for hep C virus to hang out
and wait between patients.


Steve Harris
You can email me at
But remove the numerals in the address first.


Our nada who art in Nada
Nada be thy nada..

            -- Dada Hemingway

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