Patients at New Jersey surgery center possibly exposed to HIV, hepatitis

More than 3,000 patients at New Jersey surgery center possibly exposed to HIV, hepatitis
The patients may have been exposed to blood-borne illnesses due to "lapses in infection control in sterilization," according to the surgery center.
By Kalhan Rosenblatt

An ambulatory surgery center in New Jersey may have exposed thousands of patients to HIV and hepatitis due to "lapses in infection control" and sterilization, the state's department of health said Monday.

More than 3,700 patients who had procedures at HealthPlus Surgery Center in Saddle Brook, New Jersey, may have been exposed to blood-borne illnesses such as HIV, hepatitis B, and hepatitis C, according to a statement from the center.

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https://www.nbcnews.com/news/us-news/more-3-000-patients-new-jersey-surgery-center-possibly-exposed-n951791

Drug thefts at VA hospitals are still at epidemic levels

Drug thefts at VA hospitals are still at epidemic levels
by Jazz Shaw
We always knew that the VA scandal was going to take a long time to clean up (assuming that’s even possible) but precisely how long should the public be willing to wait? While wait times have decreased overall (significantly in some cases) and we’re seeing a bit more transparency, other problems remain pervasive. One of these is the issue of drug theft at VA hospitals.

This story has been coming to a head for a while now. In early February, three workers at a VA hospital in Arkansas were charged with stealing Oxycodone, Hyrocodone and Viagra and selling the drugs on the black market. In Baltimore, a worker infected with Hepatitis C confessed to taking syringes of painkillers intended for veterans going into surgery, shooting up the drugs himself and refilling them with saline solution which was then administered to the veteran. This resulted in the patients not only getting the painkillers required for surgery, but in at least one case contracting Hepatitis from the thief.

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Unlicensed Calgary dentist shut down - AHS urges patients to get tested for HIV, hepatitis B and C

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Unlicensed Calgary dentist shut down amid public health warning. AHS urges patients to get tested for HIV, hepatitis B and C.

Preventing Disease Transmission in Dental Settings

CDC Expert Commentary
Preventing Disease Transmission in Dental Settings

Infection Transmission in Dental Healthcare

Reports of transmission of infectious agents between patients and dental healthcare personnel (DHCP) in dental settings are rare. However, a recent Centers for Disease Control and Prevention (CDC) article in the Journal of the American Dental Association[1] identified three published reports describing the transmission of hepatitis B virus and hepatitis C virus in dental settings since 2003. In addition, the Morbidity and Mortality Weekly Report[2]—published April 8, 2016—described a 2015 outbreak of Mycobacterium abscessus infection at a pediatric dentistry practice.

In most cases, investigators have failed to link a specific lapse of infection prevention and control practice with a particular transmission. However, reported breakdowns in basic infection prevention practices included unsafe injection practices, failure to heat-sterilize dental handpieces between patients, failure to monitor (eg, conduct spore testing of) autoclaves, and failure to maintain dental unit waterlines. These reports highlight the need to improve understanding of and

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Chronic Pain Center Infects Seven Patients With HCV

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.

http://www.idse.net/Hepatitis/Article/06-16/Chronic-Pain-Center-Infects-Seven-Patients-With-HCV/36587

Hospitals in Three States Offer Patients Free Tests Following Arrest of Surgical Technician for Allegedly Stealing Fentanyl from Operating Room

Hospitals in Three States Offer Patients Free Medical Laboratory Tests Following Arrest of Surgical Technician for Allegedly Stealing Fentanyl from Operating Room

Because of possible exposure to HIV, hepatitis B, and hepatitis C from a healthcare worker, thousands of patients treated in multiple hospitals in different states are being offered free clinical laboratory testing. This situation is attracting national media attention and is a reminder to pathologists and medical laboratory professionals of the increased transparency that is being given to different types of medical errors that expose patients to risk.
A surgical technologist who allegedly stole the drug fentanyl from multiple hospitals provides an example of how the healthcare system can miss systematic misconduct by individual employees that can put thousands of patients at risk.


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Thousands recalled for hepatitis C test after NHS worker's diagnosis

Thousands recalled for hepatitis C test after NHS worker's diagnosis

More than 8,000 people advised to have blood test after Lanarkshire health trust finds two former patients probably infected

More than 8,000 patients who may have been treated by a former NHS healthcare worker who tested positive for hepatitis C are being advised to have a blood test, Lanarkshire health trust said.

The trust is contacting patients who may have had a surgical procedure carried out by the NHS employee before the worker tested positive for the virus in 2008 and ceased clinical practice.

At the time the individual tested positive, the UK Advisory Panel advised that a patient notification exercise was not necessary, the trust said. It was being done now because its health protection team had been made aware of two patients who were probably infected with the virus during procedures carried out by the healthcare worker.

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SCOTLAND LEADS HEPATITIS C PATIENT NOTIFICATION EXERCISE

Public Health England (PHE) has been working closely with NHS Lanarkshire, NHS England and other agencies in other parts of the UK to notify patients who may have had a surgical procedure carried out by the former healthcare worker between 1982 and 2008.

Advice from Scottish and UK experts is that the risk of the hepatitis C virus having been transmitted to a patient during surgery involving the healthcare worker is low.

8,443 patients, mainly from Lanarkshire, but also from across Scotland and the rest of the UK, are receiving letters this week informing them of the situation and recommending that they arrange an appointment for a blood test. Only patients who have received a letter need to undergo hepatitis C testing. There are 336 patients in total in England who are being contacted.

Dr James Sedgwick, Consultant Epidemiologist at PHE said:

We would like to reassure people that the likelihood of patients acquiring the virus from a surgical procedure carried out by the healthcare worker is low.

We know that some people receiving the letter will be concerned about what this means for them. Although the risk of infection is low, we are recommending that people take up the offer of a blood test to ensure that anyone who may have the virus can receive the right treatment. The latest treatment for hepatitis C is very effective.

To ensure a consistent and coordinated approach for all patients, PHE and NHS Lanarkshire have been working with partner organisations and agencies including:
other Scottish health boards
Health Protection Scotland
NHS England
Public Health Agency of Northern Ireland
Public Health Wales
UK Advisory Panel for Healthcare Workers Infected with Blood Borne Viruses (UKAP)

Prior to 1982, the healthcare worker worked in England. Hospital trusts where the healthcare worker was employed are being contacted to determine whether records are available to identify patients who underwent surgical procedures performed by the healthcare worker during this period. Any further patients identified in England will be contacted by letter and invited for testing.

Videos and other information about hepatitis C and the public health exercise are available at www.nhslanarkshire.org.uk. More information about hepatitis C is also available from the Hepatitis C Trust.

Source 

Seattle Children’s Bellevue clinic warns of potential infection risk

Seattle Children’s Bellevue clinic warns of potential infection risk
Originally published August 26, 2015 at 2:59 pm Updated August 27, 2015 at 7:01 am

Hospital staff are sending out warnings to patients and their families and asking the patients to come in for blood tests for diseases, including hepatitis B and C and HIV.

By Sandi Doughton
Seattle Times science reporter

Up to 12,000 children and young adults treated at Seattle Children’s Bellevue Clinic and Surgery Center since 2010 could be at risk of infection from surgical instruments that may not have been properly sterilized.

The hospital is sending out warnings to patients and their families, offering free tests for blood-borne viruses, including hepatitis B and C and HIV, said hospital Chief Executive Officer Dr. Jeff Sperring.

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Newsweek Story Updated: David Kwiatkowski lab tech who is serving a 39-year sentence for infecting people with hepatitis C

Hospital Horror Story: Confessions of a Night Shift Junkie

Yesterday Newsweek updated their story on David Kwiatkowski, dubbed the "traveling lab technician" who caused the disastrous hepatitis C outbreak at Exeter Hospital in New Hampshire. Kwiatkowski regularly stole syringes filled with the drug fentanyl, after injecting himself he refilled the contaminated syringes with saline to be used on future patients.

Update: This article was updated to include a response by the Baltimore V.A.

Hospital Horror Story: Confessions of a Night Shift Junkie

BY KURT EICHENWALD / JUNE 18, 2015 6:07 AM EDT

Gripping the drug-filled syringe, David Kwiatkowski furtively glanced around to confirm that none of his co-workers could see him. Then Kwiatkowski, a radiology technician at Arizona Heart Hospital, darted into an employee locker room, found an empty bathroom stall and locked himself inside. Sweat dripped from his face, and his stomach churned; he desperately needed a fix. Minutes earlier, he had snagged one of the syringes nurses preloaded with drugs before leaving them unattended in the operating room. It was labeled “fentanyl,” an opiate many times more potent than heroin and Kwiatkowski’s latest narcotic of choice.

Continue reading here........

Outbreaks highlight infection risks associated with drug diversion

Outbreaks highlight infection risks associated with drug diversion

June 2nd, 2014 10:24 am ET - CDC's Safe Healthcare Blog

Author: Joseph Perz, DrPH, MA
Quality Standards and Safety Team Leader for the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention 

When prescription medicines are stolen or used illegally, it is called drug diversion.

Prescription opioid addiction has reached epidemic proportions and is a major driver of drug diversion . One aspect of drug diversion that is not well recognized involves healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms.

These include:
Substandard care delivered by an impaired healthcare provider,
Denial of essential pain medication or therapy, or
Risks of infection (hepatitis C virus, hepatitis B virus, HIV, bacterial infection) if a provider tampers with injectable drugs.

CDC and state and local health departments have helped investigate outbreaks that occurred when healthcare providers tampered with injectable drugs. Along with my CDC colleague Dr. Melissa Schaefer and I recently published a summary of six of these outbreaks, which were investigated over the last ten years.

These outbreaks revealed gaps in prevention, detection, and response to drug diversion. To prevent diversion, healthcare facilities should enforce strong narcotics security measures and maintain active monitoring systems. Appropriate response when diversion is suspected or identified includes prompt reporting to enforcement agencies and assessment of harm to patients, including assessment of possible infection risks. 

Drug Diversion in Healthcare Settings

Medscape: Expert Video Commentary
View video here, or read transcript below. 

Read The Full Text Article; Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

Hi. I'm Dr. Joe Perz, a healthcare epidemiologist at the Centers for Disease Control and Prevention (CDC). I'm pleased to be speaking with you today as part of the CDC Expert Video Commentary series on Medscape. I will be addressing the issue of drug diversion.

Drug diversion can be defined as any act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient. Prescription opioid addiction, which has reached epidemic proportions in some areas of the United States, is a major driver of drug diversion

This commentary will focus on diversion involving healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms, including substandard care delivered by an impaired provider, denial of appropriate therapy or pain control, and even infection risks stemming from tampering with injectable drugs. Healthcare professionals who divert drugs risk losing their licenses, credentials, and employment; they even risk losing their lives if they overdose. Consequences may also include litigation or imprisonment.

At CDC, I lead a group that monitors outbreaks of healthcare-associated infections. We recently published a manuscript in the journal Mayo Clinic Proceedings.[1]

In that article, we describe 6 outbreak investigations over the past 10 years in which diversion -- specifically tampering with controlled substances -- resulted in the transmission of infections. Two outbreaks involved tampering with opioids administered by patient-controlled analgesia pumps, which introduced contaminants and resulted in gram-negative bacteremia in 34 patients. The remaining outbreaks involved personnel who tampered with syringes or vials containing fentanyl. This involved, for example, self-injecting fentanyl from a syringe, replacing the contents with a clear solution such as saline, and returning the syringe to the procedure area or anesthesia cart. In these 4 outbreaks, hepatitis C virus (HCV) infection was transmitted to at least 84 patients. In each of these 4 outbreaks, the implicated professional was HCV-infected and served as the source. Nearly 30,000 patients were potentially exposed to bloodborne pathogens and targeted for notification advising testing.

Our review probably underestimates the burden of infections resulting from diversion. Making the connection between unexplained or difficult-to-detect infections on the one hand, and illicit, concealed drug diversion activities on the other hand, is extremely difficult. Our review also does not in any way adequately reflect the frequency of diversion by healthcare personnel in the United States. It has been reported that more than 100,000 US doctors, nurses, technicians, and other health professionals struggle with abuse or addiction.[2] Prescription drugs and controlled substances such as oxycodone and fentanyl are often involved. A manager of controlled substance surveillance at one hospital recently reported identifying at least 1 healthcare provider each month stealing medication from the facility.[3] What sets this institution apart from others? Perhaps nothing more than the fact that it has a program to actively monitor for diversion activity.

Patient safety and professional safety all demand effective, reliable safeguards to maintain the integrity of prescription drugs and controlled substances. Here are 3 things that you can do, whether your role is that of a manager or healthcare professional: Prevent, detect, and respond.

Prevent.
Prevention always comes first. Healthcare facilities are required to have systems in place to guard against theft and diversion of controlled substances. It is important that all staff understand and comply with these protocols, acting in ways to minimize unauthorized access or opportunities for tampering and misuse.

Detect.
Even with such prevention safeguards, healthcare facilities must have systems to facilitate early detection. These systems can include active monitoring of pharmacy and dispensing record data, as well as having staff who are aware of and alert for behaviors and other signs of potential diversion activity.

Respond.
This leads to the third action: response. For staff, this can be summarized as "see something, say something." Appropriate response at the institutional level includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.

In closing, consider the ubiquitous nature of controlled substances in many healthcare environments -- settings where you provide care or help to manage. Access to these drugs must be tightly managed and monitored for the good of your fellow staff and your patients. Maintaining the security of controlled substances is a shared responsibility. Working together, we can raise awareness and strengthen protections in this area.

Web Resources

CDC: Injection Safety
CDC: Risks of Healthcare-Associated Infections From Drug Diversion
CDC: One and Only Campaign
CDC: Impacts Related to Unsafe Injection Practices
Minnesota Hospital Association Drug Diversion Prevention Toolkit
Premier Drug Diversion

Dr. Joseph Perz is the Ambulatory and Long Term Care Team Leader for the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. Dr. Perz entered the field of public health after training as an engineer and environmental scientist. After receiving a doctorate in public health from Columbia University, he served as an epidemic intelligence service officer with the Tennessee Department of Health. During his 15 years with the CDC, Dr. Perz has guided dozens of outbreak investigations and special studies, drawing attention to the need for injection safety and other basic infection control. He has authored or coauthored over 50 peer-reviewed journal articles, Morbidity and Mortality Weekly Report articles, and book chapters. His team's activities are currently focused on interagency collaboration, support to health departments, and partnership efforts to expand prevention activities to ambulatory and long-term care settings.

Video- Settlement for women over hepatitis C infections

Doctors, medical staff on drugs put patients at risk

Doctors, medical staff on drugs put patients at risk
By Peter Eisler 

A single addicted health care worker who resorts to “drug diversion,” the official term for stealing drugs, can endanger thousands. Nearly 8,000 people in eight states needed hepatitis tests after David Kwiatkowski, an itinerant hospital technician, was caught injecting himself with patients’ pain medicine and refilling the syringes with saline. He infected at least 46, mostly in New Hampshire.

It was the third hepatitis outbreak since 2009 linked to a health care worker using patients’ syringes (the others were in Denver and Jacksonville, Fla). And for each of those worst-case scenarios, there are countless more practitioners whose drug-related errors are more isolated — a botched surgery, an incorrect dose of medication, a worrisome vital sign missed.

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Hepatitis C - ADA Statement on Infection Control in Dental Settings

ADA Statement on Infection Control in Dental Settings

Written by Dentistry Today Thursday, 26 September 2013 07:51

CHICAGO, Sept. 19, 2013 – The American Dental Association (ADA) is deeply concerned about the first confirmed report of patient to patient transmission of hepatitis C in a dental practice setting linked to improper infection control practices. The ADA wishes to assure the public that patient health and safety are top priorities for the Association.

“This is a highly atypical and disconcerting case,” states ADA President Robert A. Faiella, D.M.D., M.M.Sc. “Every day, hundreds of thousands of dental procedures are performed safely and effectively thanks to the diligence of dentists who follow standard infection control precautions developed by the Centers for Disease Control.”

Dr. Faiella added, “While this is an isolated case, it understandably raises questions about infection control in the dental office. The ADA encourages people to talk with their dentists, who will be glad to explain or demonstrate their infection control procedures.”

The statement issued today is part of an interim status report from the Oklahoma State Department of Health and the Tulsa Health Department on the results of their joint investigation of the dental surgical practice with offices in Tulsa and Owasso. The oral surgeon involved in the case voluntarily surrendered his license to practice.

 The investigation began March 28 when public health officials notified the practice’s former patients that they may have been exposed to blood-borne viruses.

 An epidemiological investigation indicated that one case of transmission of the virus occurred in the dental practice. The transmission was described as “patient-to-patient” because improper infection control procedures caused the virus to be passed from one patient to another. Genetic-based testing of patient specimens by the Centers for Disease Control and Prevention (CDC) provided laboratory confirmation of the finding.

 The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use standard precautions as described in the Centers for Disease Control and Prevention’s (CDC) Guidelines for Infection Control in Dental Health Care-Settings.
Standard precautions protect patients and health care workers by preventing the spread of disease. Examples of infection control in the dental office include the use of masks, gloves, surface disinfectants and sterilizing reusable dental devices.

 Before any patient enters the examining room, all surfaces, such as the dental chair, dental light, instrument tray, drawer handles and countertops, have been cleaned and decontaminated. Some offices may cover this equipment with protective covers, which are replaced after each patient.

Non-disposable items like dental instruments are cleaned and sterilized between patient appointments. Disposable dental instruments and needles are never re-used. Infection control precautions also require all dental staff involved in patient care to use appropriate protective garb such as gloves, masks, gowns and eyewear. After each patient, all disposable wear items, such as gloves, are discarded. Before seeing the next patient, the members of the treatment team cleanse their hands and put on new gloves.

 More information on infection control in dental offices is available online on the ADA consumer website Mouthhealthy.org.

After hepatitis C probe, NH, groups push for better drug diversion prevention, detection

After hepatitis C probe, NH, groups push for better drug diversion prevention, detection

By Associated Press, Updated: Monday, September 23, 1:30 PM

CONCORD, N.H. — After spending a year investigating the hepatitis C outbreak at Exeter Hospital, New Hampshire’s public health department is working with two advocacy groups to share its recommendations.

Chris Adamski of the state Department of Health and Human Services said Monday her office is committed to working with all partners to promote better prevention and detection of drug diversion. Those partners now include the Maryland-based National Association of Drug Diversion Investigators and a patient advocacy group called Hepatitis Outbreaks National Organization for Reform, or HONOReform, Nebraska.

 

Continue reading.... 

 

 

NHS hepatitis C infection warning for women

NHS hepatitis C infection warning for women

Women who gave birth or had an obstetric or gynaecological operation at 16 UK hospitals between 1975 and 2003 may have come into contact with a healthcare worker infected with hepatitis C.

While the risk of infection is small, the numbers affected likely to be few and the health consequences may not be particularly noticeable, concerned women should seek help and advice.

It has recently come to light that the healthcare worker transmitted the virus to two patients while working at Caerphilly District Miners Hospital in Wales from 1984 until they stopped working with patients in 2002.

A helpline for worried patients will open tomorrow
(Thursday September 12) at 9am on freephone 0800 121 4400

Fewer than 400 women in England have so far been identified as having definitely or possibly had operations conducted by the affected healthcare worker. They will be contacted directly and blood tests can arranged at their GP practice.

What is being done to help women potentially infected?

Local health officials are looking at more than 3,000 former hospital patients’ notes and records from the Caerphilly District Miners Hospital (where the worker was employed for nearly 20 years). Around 200 former hospital patients from two other hospitals in Wales where the healthcare worker practised for a short time are also being contacted. 

Those patients identified as exposed or possibly exposed to hepatitis C are being sent individual letters and asked to call a special confidential helpline, inviting them to attend a hospital clinic or, if they have moved away from the area, their GP for a blood test. Treatments for hepatitis C will be offered if necessary.

As it has been almost 30 years since the individual worked in hospitals in England, records of women who may be at risk are in some cases incomplete, for example if the hospital has been renamed or patients have moved around the country.

Who might potentially be at risk from hepatitis C infection?

The person worked in obstetrics and gynaecology at several hospitals around the UK between 1975 and 2003. Potentially, women who gave birth or had obstetric/gynaecological operations at these hospitals may be at a small risk of infection. The hospitals in question are:

Grimsby General Hospital (September 3 1975 to March 6 1978) – now Diana, Princess of Wales Hospital
Burnley General Hospital (April 5 to 30 1978)
Wrexham Maelor Hospital (May 15 to June 27 1978)
Bedford Hospital (July 3 to August 6 1978 & November 4 to 19 1978)
City General Hospital, Carlisle (August 31 to September 17 1978 and April 12 to May 2 1982) – now Cumberland Infirmary
Herts and Essex Hospital (December 4 1978 to January 10 1979)
The Mid Ulster Hospital, Magherafelt (January 11 to November 4 1979)
All Saints Hospital, Kent (November 5 to 16 1979) – now Medway Maritime Hospital
Fife Hospitals (March 25 to July 3 1981)
Stepping Hill Hospital, Stockport (July 20 to November 2 1981)
Doncaster Gate Hospital, Rotherham (July 23 to August 18 1982) – now Rotherham Hospital
Royal Victoria Hospital, Boscombe (September 27 to October 10 1982) – now the Royal Bournemouth and Christchurch NHS Foundation Trust
Royal General Hospital, Treliske (February 8 to March 19 1983 & May 9 to June 21 1983) – now the Royal Cornwall Hospital
Peterborough District Hospital (November 28 to December 2 1983) – now Peterborough City Hospital
East Glamorgan Hospital (May 28 1984 to July 17 1984)
Caerphilly District Miners Hospital (May 1984 to July 2003)


What is the risk if you were treated at these hospitals?

Public Health England says that there is only a small chance that a patient might acquire hepatitis C infection through surgical contact with an infected healthcare worker. The risk is very low as this can only occur if the healthcare worker is infectious and leads or assists in an operation or procedure on the patient. However, even in such circumstances transmission is very rare.

What happens if you are infected with hepatitis C?

Around one in 250 adults in England have chronic hepatitis C infection and it does not automatically lead to health problems. Each year 10,000 people are newly infected.

Treatment can help clear hepatitis C in up to 80 per cent of cases, although hepatitis C can have serious complications.

Why was the healthcare worker allowed to work in the NHS while infected with hepatitis C?

Like most people who are infected with hepatitis C, the healthcare worker had no symptoms and was unaware of the infection until after they retired.

As soon as the risk of infection was recognised, and a transmission was confirmed, their occupational history was traced.

What are the symptoms of hepatitis C?

Only around one in four people will have symptoms during the first six months of a hepatitis C infection. The flu-like symptoms can include high temperature and feeling sick. Some may also experience jaundice (yellowing of the eyes and skin). 

In around three-quarters of people, the virus persists for many years (chronic hepatitis). Some may not notice symptoms but others will be greatly affected. Signs of chronic hepatitis include feeling tired all the time (with no benefit from sleep), headaches, depression, problems with short-term memory (“brain fog") and itchy skin.

What is being done about the risk of hepatitis C in the NHS?

Since 2007, all new NHS healthcare workers have been tested for hepatitis C.

Healthcare workers also have a professional duty to get tested if they consider themselves at risk of contracting a blood-borne virus.

Links to the headlines

Hepatitis fear at Welsh hospitals as patients infected. BBC News, September 11 2013

5,500 patients offered tests over Hepatitis C fears. ITV News, September 11 2013

VA Hospital Mistakes: Leaders got bonuses despite problems within their systems

Reporting by Gregg Zoroya, USA TODAY

PITTSBURGH, Pa. -- Department of Veterans Affairs officials had trouble explaining to a House committee why department officials received awards and bonuses while hospitals they oversaw were the sites of infectious disease outbreaks and suicide deaths in recent years.

Buffalo was among the cities where leaders got bonuses despite problems within their systems. The Upstate New York network director, David West, got nearly $26,000 in bonuses despite revelations that workers re-used disposable insulin pens on patients at the Buffalo hospital, putting veterans at risk of HIV or hepatitis infections.
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Video: Daily Show Takes on the VA

VA hospitals
The Daily Show host Jon Stewart is back after his 12 week break, doing what he does best - using humor to tackle the big issues of the day. Stewart's thought-provoking look at the Veteran Affairs Department may be of interest to the HCV community.

The talk show host began by checking on the progress of the VA's backlogged benefits, however, instead the comedian discovered problems at numerous VA hospitals. Stewart mentioned the legionnaires outbreak, exposure to hepatitis and the failure to monitor mental health patients.

Accountability?
Stewart wanted to know who was fired or reprimanded at the VA hospitals for mishandling the above mentioned problems. Well, the outcome may surprise you. 

Bonuses?
For instance, what about the 700 veteran's exposed to hepatitis because of reused insulin pens at the Buffalo VA? During that time upstate regional director David West was awarded over 25,000 in bonuses. What!

The Daily Show host summed up the problems at the VA with this profound statement;

"Going to an American hospital, for a veteran, shouldn't require more courage than storming the beach at Normandy"

Welcome back Mr. Stewart.




http://www.thedailyshow.com/
Watch more clips from this episode or the entire show.

Hospital Tech Pleads Guilty in Hepatitis C Outbreak

The Concord (N.H.) Monitor, Aug. 16, 2013

One of the most chilling episodes in the whole awful saga of the traveling hospital worker who pleaded guilty to a horrific drug-stealing scheme came outside the federal courthouse in Concord. There, one of David Kwiatkowski's victims told reporters that he remembered the technician from his stay at Exeter Hospital — and remembered that something was distinctly wrong with him.

The man described Kwiatkowski as sweaty and his eyes red and glassy. He figured he was either drunk or high on marijuana. That alone would have been cause for alarm — from patients and co-workers alike. Incredibly the truth was far worse.

Kwiatkowski moved regularly from job to job, often working in cardiac catheterization labs. As he has now admitted, he regularly stole syringes full of narcotics and replaced them with syringes he had already used — refilled with saline solution. That, too, would have been cause enough for alarm, for Kwiatkowski's patients were denied the painkillers they needed. But that wasn't the end of the story either.

Those old syringes were contaminated with hepatitis C, which Kwiatkowski had acquired during years of drug abuse. As a result, nearly four dozen patients in New Hampshire, Kansas and Maryland were infected with a potentially fatal virus.

Kwiatkowski will spend between 30 and 40 years behind bars, a sentence federal prosecutor John Kacavas described as the best deal available under the law. "I can't give (the victims) their health back. I can't give them compensation. ... What we can give them is some measure of justice within the criminal justice system. And that is a term of years of incarceration. I understand their frustration and I understand victims who want nothing less than a life sentence or the death penalty. I get that.

But our system does not allow for that." There may be one measure of hope — not for these patients, alas, but for the safety of future patients.

Pending at the State House is legislation intended to prevent similar drug-addicted workers from carrying such schemes from one unwitting hospital to another.

The bill would create a state board to oversee the licenses of medical technicians and a registry of the status of those licenses. If a hospital technician's license was rescinded here, it would be public knowledge, checkable by any future employer. The information would be available on a national database of health care worker licenses.

The rules for medical technicians vary from state to state. Some require certain subsets to require licenses; New Hampshire is one of many states that don't require any licensing. Clearly, licensing and registration here is an important first step.

Despite the fashionable political talk about burdensome government regulation, this is an area where less is not better. Of course, a New Hampshire registry would raise red flags about only those medical technicians who had gotten into trouble in New Hampshire.

Advocates here hope that it might eventually lead to a national registry, so that abusers like Kwiatkowski couldn't easily slip from one state to another. A national registry for health care workers is a worthy cause for members of New Hampshire's congressional delegation. New Hampshire brought this tragic problem to the nation's attention. The state should now lead the way in helping to prevent it in the future.

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Ex-Vegas MD guilty of murder in wide Hepatitis C outbreak

8 News NOW

Former prominent Las Vegas doctor and endoscopy clinic owner Dipak Desai in court July 1, 2013 after being convicted of second-degree murder, among 27 counts stemming from what's considered one of largest Hepatitis C outbreaks in U.S. history / KLAS-TV

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3 out of 20 scopes used to examine GI tracts and colons improperly cleaned

3 out of 20 scopes used to examine GI tracts and colons improperly cleaned

Scopes at 5 US hospitals analyzed for presence of 'bio dirt'

Fort Lauderdale, Fla., June 7, 2013 - Three out of 20 flexible gastrointestinal (GI) endoscopes used for screening were found to harbor unacceptable levels of "bio dirt" – cells and matter from a patient's body that could pose potential infection risk -- according to a study of endoscopes used at five hospitals across the U.S.

In an abstract to be presented at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), researchers in the 3M Infection Prevention Division analyzed 275 flexible duodenoscopes, gastroscopes, and colonoscopes and found that 30 percent, 24 percent, and 3 percent respectively did not pass a cleanliness rating.

"Three out of 20 is an unexpectedly high number of endoscopes failing a cleanliness criterion," said Marco Bommarito, PhD, lead investigator and lead research specialist, 3M Infection Prevention Division. "Clearly, we'd like no endoscopes to fail a cleanliness rating."

In the last several years there have been reports of improperly cleaned endoscopes at healthcare facilities across the country, including the Veterans Administration, in which thousands of patients required testing for HIV, as well as hepatitis B and C. According to the Centers for Disease Control and Prevention, who published guidelines for reprocessing endoscopes in 2008, more healthcare-associated outbreaks have been linked to contaminated endoscopes than to any other medical device.1 In addition, cross-contamination from flexible endoscopes has been identified by the ECRI Institute, an independent organization that researches patient safety and quality, as a leading health hazard.2

Annually between 15 and 20 million endoscopy procedures are conducted with reusable endoscope devices to screen various components of a patient's GI tract. These devices allow healthcare providers to investigate the surface of this organ and identify issues such as polyps or colon cancer. Duodenoscopes, gastroscopes, and colonoscopes examine the duodenum – or the first section of the small intestine, the stomach, and the colon, respectively.

After an endoscope is used for a procedure it is sent for cleaning before being reused with another patient. This reprocessing involves two steps: first, manual cleaning with an enzymatic cleaner and flushing by a hospital technician and second, soaking the device in a high-level disinfectant. The first step is vital to ensure that the disinfection process is effective. After manual cleaning is completed, the technician visually inspects the instrument to ensure cleanliness. However, this study has found that contamination can remain on the device and may be invisible to the naked eye.

In the study, after the manual cleaning step of the decontamination and disinfection process, cleaning technicians at five hospitals across the U.S. were asked to flush the scopes with sterile water, and this sample was analyzed by researchers for adenosine triphosphate (ATP) – a marker of bio contamination. The amount of ATP, in relative light units (RLUs), was measured with a hand-held luminometer. Based on previously published clinical data, a threshold for "pass/fail" was set at 200 RLUs.3,4 Any instruments with more than 200 RLUs were identified as a cleaning failure.

"The cleaning protocols for flexible endoscopes need improvement, such as guidelines tailored to the type of scope or identifying if there is a critical step missing in the manual cleaning process, and documented quality control measures" said Dr. Bommarito. "These types of improvements could have a positive impact on patient safety."

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The APIC 2013 Annual Conference, June 8-10 in Fort Lauderdale, is the most comprehensive infection prevention conference in the world, with 90 educational sessions and workshops led by infection prevention experts and attended by more than 4,600 individuals. The conference aims to provide infection preventionists with tools and strategies that are easily adaptable and can be implemented immediately to improve prevention programs. The Twitter hashtag #APIC2013 is being used for the meeting.

Oral Abstract #040 – A Multi-site Field Study Evaluating the Effectiveness of Manual Cleaning of Flexible Endoscopes with an ATP Detection System

About APIC
APIC's mission is to create a safer world through prevention of infection. The association's more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Follow APIC on Twitter: http://twitter.com/apic.

http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf, p. 13, accessed: 5/23/13.
https://www.ecri.org/Documents/Reprints/Preventing_Patient_Cross-Contamination_from_Flexible_Endoscopes%28TechNation%29.pdf, p. 1, accessed: 5/23/13.
Michelle J. Alfa, Iram Fatima, Nancy Olson; The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels; American Journal of Infection Control, Vol. 41, Issue 3, March 2013, pp. 249-253.
Michelle J. Alfa, Iram Fatima, Nancy Olson; Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels; American Journal of Infection Control, Vol. 41, Issue 3, March 2013, pp. 245-248.