JUNE 6, 2016
Chronic Pain Center Infects Seven Patients With HCV
By IDSE News Staff
The Centers for Disease Control and Prevention (CDC) has found that a pain clinic in California that delivered prolotherapy for chronic pain infected seven patients with hepatitis C virus (HCV) (MMWR Morb Mortal Wkly Rep 2016;65[21]:547-549).
The index patient was alerted of the infection by a blood bank in 2014. The patient had no symptoms of HCV and no known risk factors, such as injection drug use, incarceration or long-term hemodialysis. A regular blood donor, the patient had been HCV negative 56 days before this donation.
Public health officials investigated possible exposures in this 56-day period and found that the blood donor had received prolotherapy, also known as regenerative injection therapy, from a chronic pain clinic that practices complementary and alternative medicine (CAM). Prolotherapy is a CAM treatment for chronic musculoskeletal pain. Substances commonly injected include hypertonic dextrose, phenol-glycerin-glucose and moorhuate sodium (a mixture of saturated and unsaturated fatty acids from cod liver oil), according to the MMWR report. Some patients also received platelet-rich plasma, which uses autologous blood with a high ratio of platelets to plasma.
According to the CDC, there are no practice guidelines for this procedure, nor are there formal training programs.
Infection control practices in the chronic pain clinic were absent, the CDC said. Breaches included reentering multidose medication vials for use in several patients, poor hand hygiene, inconsistent glove use, and lack of aseptic technique when handling injection equipment and medication.
After the investigation, the Santa Barbara County Public Health Department closed the clinic.
The county health department, the California Department of Public Health and the CDC began investigating other possible exposures, not only for HCV, but also HIV and hepatitis B virus (HBV). The agencies sent warning letters to 400 patients who were potentially infected with a bloodborne pathogen after visiting the clinic in the previous 10 months. They found six other patients who also were infected with HCV. Four of the patients had no known exposures to HCV, nor previous positive tests, but had an injection procedure the same day as the index patient. No one came down with HBV or HIV.
“Identification of a case of acute HCV infection in a frequent blood donor without other risk factors should be considered a sentinel event and should prompt public health investigation,” the CDC said.
In addition, the CDC said ambulatory clinics that practice CAM therapies should consider infection control training and might benefit from inclusion in health care–associated infection surveillance networks, such as the CDC’s National Healthcare Safety Network.
Chronic Pain Center Infects Seven Patients With HCV
By IDSE News Staff
The Centers for Disease Control and Prevention (CDC) has found that a pain clinic in California that delivered prolotherapy for chronic pain infected seven patients with hepatitis C virus (HCV) (MMWR Morb Mortal Wkly Rep 2016;65[21]:547-549).
The index patient was alerted of the infection by a blood bank in 2014. The patient had no symptoms of HCV and no known risk factors, such as injection drug use, incarceration or long-term hemodialysis. A regular blood donor, the patient had been HCV negative 56 days before this donation.
Public health officials investigated possible exposures in this 56-day period and found that the blood donor had received prolotherapy, also known as regenerative injection therapy, from a chronic pain clinic that practices complementary and alternative medicine (CAM). Prolotherapy is a CAM treatment for chronic musculoskeletal pain. Substances commonly injected include hypertonic dextrose, phenol-glycerin-glucose and moorhuate sodium (a mixture of saturated and unsaturated fatty acids from cod liver oil), according to the MMWR report. Some patients also received platelet-rich plasma, which uses autologous blood with a high ratio of platelets to plasma.
According to the CDC, there are no practice guidelines for this procedure, nor are there formal training programs.
Infection control practices in the chronic pain clinic were absent, the CDC said. Breaches included reentering multidose medication vials for use in several patients, poor hand hygiene, inconsistent glove use, and lack of aseptic technique when handling injection equipment and medication.
After the investigation, the Santa Barbara County Public Health Department closed the clinic.
The county health department, the California Department of Public Health and the CDC began investigating other possible exposures, not only for HCV, but also HIV and hepatitis B virus (HBV). The agencies sent warning letters to 400 patients who were potentially infected with a bloodborne pathogen after visiting the clinic in the previous 10 months. They found six other patients who also were infected with HCV. Four of the patients had no known exposures to HCV, nor previous positive tests, but had an injection procedure the same day as the index patient. No one came down with HBV or HIV.
“Identification of a case of acute HCV infection in a frequent blood donor without other risk factors should be considered a sentinel event and should prompt public health investigation,” the CDC said.
In addition, the CDC said ambulatory clinics that practice CAM therapies should consider infection control training and might benefit from inclusion in health care–associated infection surveillance networks, such as the CDC’s National Healthcare Safety Network.
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