Washington, Mar 5: An outbreak of hepatitis C at a clinic in the Western state of Nevada might represent "the tip of an iceberg" of safety problems at clinics around the country, says the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and January 11 to urge them to be tested for hepatitis C, hepatitis B and HIV.

In Washington, Senate Majority Leader Harry Reid, met Monday with CDC director Dr Julie Gerberding, and the Democratic leader shared a media conference call with her after their meeting. Both strongly condemned practices at the clinic.

Health care accreditors "would consider this a patient safety error that falls into the category of a 'never event,' meaning this should never happen in contemporary health care organizations," said Gerberding.

"This is the largest number of patients that have ever been contacted for a blood exposure in a health care setting. But unfortunately we have seen other large-scale situations where similar practices have led to patient exposures," Gerberding said.

"Our concern is that this could represent the tip of an iceberg, and we need to be much more aggressive about alerting clinicians about how improper this practice is," she said.