Inadvertent exposure of endoscopy patients to viral hepatitis B

During 6 months of surveillance for hepatitis B surface antigen (HBsAg) in patients undergoing endoscopy in a hospital, 4(2%) of 199 patients were found to be positive. Only 1 of the 4 was previously known to be an HBsAg carrier. The first 5 patients endoscoped after each of 2 HBsAg-positive index patients were followed prospectively for evidence of hepatitis B infection. The endoscope used was routinely cleaned and disinfected (not sterilized) after each use. Transmission of viral hepatitis B was not demonstrated even though the index patients were “e” antigen positive. Our results show that inadvertent contamination of endoscopes with blood and saliva from HBsAg-positive patients occurs frequently (1.5% of 199 endoscopies) and suggest that meticulous cleaning and disinfection of endoscopes after all procedures may diminish the risk of hepatitis B transmission by this route.