A Nevada clinic linked to an outbreak of hepatitis C may be just an indication of a much bigger problem involving safety procedures at clinics throughout the rest of the country, warned the US Centers for Disease Control and Prevention.

An endoscopy center in Southern Nevada was shut down last Friday following findings by state health officials that six patients had contracted hepatitis C due to unsafe practices. The clinic staff had been reusing syringes and vials to administer injections of anesthesia to about 40,000 patients from March 2004 to Jan. 11 this year. These patients will have to get tested for hepatitis C, hepatitis B and HIV, according to state health officials.

Health officials suspect that the center reused syringes and also used a single vial of anesthesia medication on several patients, resulting in exposure of endoscopy patients to the blood of others.

Of the six infected patients, five were treated on the same day while the sixth may have been infected about two months earlier, health officials said. The connection to the clinic was established through genetic testing.

Hepatitis C virus can lead to jaundice, fatigue, and fatal liver disease, although four-fifths of infected people do not show any symptoms. Hepatitis B is rarer but more serious and also attacks the liver. Hepatitis C virus spreads via blood-to-blood contact with the blood of an infected person; there is no vaccine against it.

The head of CDC strongly condemned the practices at the clinic, saying these are things that should never happen in contemporary health care organizations.

The CDC head also said the 40,000 estimated patients is the largest number ever to have been exposed in a health-care environment, but this could only be the tip of an iceberg. There have been other large-scale situations where similar clinical practices have been followed, leading to exposures. This is the more troubling aspect of the incident.

The US Senate Majority Leader, who comes from Nevada, said the Senate and the CDC would try to find ways to allocate more resources, to enable the CDC to become more aggressive in detecting unsafe, bad clinical practices and in alerting patients for testing.

Meanwhile, a second Nevada endoscopy clinic with links to the first one is also under investigation. Health officials have already found that the clinic reused anesthetic vials but did not do the same for syringes. The state health department is still trying to assess whether there is need to notify patients of potential risk.

Safety Tip:

• Check that syringe. Make sure the person administering injections on you is using a brand-new syringe. Remind him or her about it, if you think it is in order.

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