Patients who got hepatitis from contaminated syringes and medicine vials are joining infection control advocates to warn Americans about a problem they say is more common than people think. A recent federal report suggests they are right.
It found more than 60,000 people were exposed to hepatitis, and at least 400 people were infected with it in 33 outbreaks linked with blatant safety violations. The report covered the period from 1998 to 2008.
Many involved reuse of syringes: Health workers likely thought they were being safe by discarding the syringes' used needles and snapping on sterile ones. They were apparently unaware that the plastic barrel part of a syringe can become contaminated, too. Reusing it even with a fresh needle also can contaminate the medicine vial.
Army officials announced Thursday they are investigating evidence that a similar unsanitary practice, reuse of insulin-injecting devices, may have occurred at a Texas Army hospital. More than 2,100 diabetic patients treated at William Beaumont Army Medical Center in El Paso may be at risk for hepatitis or HIV, although no cases have been confirmed.
Authorities believe many infections from such incidents go unreported. The lack of care and cleanliness that has been uncovered in medical clinics and doctors' offices is disturbing. The most publicized cases in recent years occurred in Nevada, Nebraska and New York; one of the most recent outbreaks was in Illinois.
But they have happened in other states and in hospitals, too. The federal report published last month says the cases it highlights "probably represent a much wider problem."
Some hygiene lapses among medical workers have received more attention, including inadequate hand-washing. But researcher Joseph Perz of the Centers for Disease and Prevention said that syringe reuse "is something that's obviously wrong."
"It really represents a breakdown in very basic patient safety. There really is a sense of outrage among many providers and others working in this area when they hear about some of these outbreaks and some of the practices," Perz said. He co-authored the report, which appeared in the Jan. 6 edition of Annals of Internal Medicine.
Perz blamed the problem on ignorance and lack of oversight.
According to the CDC, sometimes doctors or nurses injected several patients from single-use medicine vials — to "cut corners," Perz said, or, some authorities believe, to save money.
The CDC is working with patient advocates to raise awareness about the problem and Perz is among those speaking at a Washington, D.C., conference next week. The coalition includes infection control specialists and nurse anesthetists.
The campaign is designed to alert doctors, nurses and other medical workers that syringes must only be used once. Patients should be watchful, too, asking about safety precautions and speaking up if they see or suspect a violation.
The campaign will include a Web site and written training materials, and is to kick off later this month in Nevada. In an outbreak there made public last year, at least nine hepatitis cases were directly linked to reuse of syringes and vials at two now-closed Las Vegas outpatient clinics. Another 105 cases were considered possibly linked to the clinics' practices.
Hepatitis is a viral infection of the liver. The most common, form, hepatitis C, afflicts more than 3 million Americans, is potentially life-threatening and can cause permanent liver damage. It may cause no initial symptoms and can go undetected for years.
Here's how hepatitis — and other blood-borne diseases like the AIDS virus — can be spread even if a needle is not reused:
Plastic syringes with snap-on needles are used to draw medicine from a vial. The drug is then injected into a patient who may be carrying hepatitis, but may not know it. The virus in the patient's blood can seep back into the syringe barrel, and then into any medicine vial used with the now-contaminated syringe.
The risk of infection exists even if new sterile needles are attached to the contaminated syringe, and even if a new sterile syringe and needle are used once the vial is contaminated. At that point, the medicine can carry the hepatitis virus to another patient.
A leader of the awareness movement is Evelyn McKnight, who learned in 2002 that she had contracted hepatitis C through chemotherapy for breast cancer. Syringes that had been used on a hepatitis-infected cancer patient at the Fremont, Neb., clinic were reused along with a saline bag that also had become contaminated.
McKnight, 54, was among 99 patients who were infected with hepatitis at the clinic. A doctor and nurse lost their licenses in that case.
McKnight, who is cancer-free now, said she had six months of expensive drug treatment and is doing OK. But she said the awful experience led her to form the advocacy group.
"I just knew that I wanted something good to come from this," she said.
Two more recent hepatitis outbreaks occurred in the Chicago area, reported in 2007 and 2008, sickening 14 patients at two assisted-living centers. One was linked with reuse of devices used to test blood sugar levels in diabetic patients, the other to inadequate hand-washing between finger-stick procedures on diabetic patients, the CDC report said.