Q & A on largest patient look-back effort in history
Forty thousand patients have plenty of questions
The Southern Nevada Health District issued the following questions and answers after launching the largest patient look-back effort in history by contacting 40,000 patients potentially exposed to bloodborne pathogens in a Las Vegas endoscopy clinic:
• Why is the health district making these recommendations? The health district received notification of three acute cases of hepatitis C in January 2008 and has identified a total of six cases to date. Five of the cases had procedures requiring injected anesthesia on the same day. Following a joint investigation with the Nevada State Bureau of Licensure and Certification (BLC) and with consultation from the Centers for Disease Control and Prevention, the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients. The exposures did not result from the medical procedures performed.
• How were the cases discovered? The cluster of illnesses came to the attention of the health district in January 2008. These cases were reported to the health district by area physicians. Nevada law requires that medical providers notify public health officials when they identify a number of different diseases, including hepatitis C. The common link between cases was identified through the routine investigation of the cases reported by medical providers, which includes an interview of the patient.
• Why did it take several months for this to come to the attention of the health district? Most people infected with hepatitis C virus do not develop symptoms and do not know that they have been infected. As a result, these infections would not have been reported to the health district. An infection with hepatitis C that results in the patient developing symptoms (acute disease) is rare so it is an unusual occurrence that brought this problem to the attention of the health district. On average, two cases of acute hepatitis C are reported each year in Clark County. Six cases have been identified in relation to this investigation.
• How were patients exposed? A syringe (not a needle) that was used to administer medication to a patient was reused on the same patient to draw up additional medication. The process of redrawing medication using the same syringe could have contaminated the vial from which the medicine was drawn with the blood of the patient. The vial, which was not labeled for use on multiple patients, was then used for a second patient (with a clean needle and syringe). If that vial was contaminated with the blood of the first patient, any subsequent patients given medication from that vial could have been exposed to bloodborne pathogens. (See graphic, below.)
• How did you determine the link between these cases? Of the six known cases, five had procedures on the same day. Genetic testing on four of the cases from that day has identified they likely came from a common source. The patient who had a procedure on a different day does not share a common source as the other four. This indicates the problem that allowed disease transmission to occur was not a one-time event, but had recurred over an extended period of time. Investigation of the clinic practices identified common practices, which would allow disease to be transmitted in that manner.
• What actions have been taken to correct the unsafe injection control practices? The unsafe injection practices associated with these cases were identified during the investigation conducted in mid-January. The injection practices that lead to the exposure have been corrected, so no new patient exposures should be occurring. As it can take several months for the symptoms of hepatitis C to appear, additional cases might be identified despite no ongoing transmission of disease.
• Why is the health district also recommending testing for hepatitis B and HIV? The investigation revealed practices that could have exposed patients to the blood of another patient. Although hepatitis C was the focus of the investigation, hepatitis B and HIV can be transmitted in the same manner.
• How many people will be diagnosed with hepatitis C, B, or HIV from this investigation? It is unknown how many people were infected at the clinic. Hepatitis C, B, and HIV are routinely found in the population. A significant number of people might have been infected prior to their procedure. Although testing can determine if a person is infected, it cannot determine the source of the infection.
• How serious are these illnesses? Hepatitis C, B, or HIV can result in a range of disease severity, and can eventually result in death. It is important that patients speak with a physician or health care provider if you have one of these diseases. A physician will be able to address specific risks for serious illness and develop a plan to monitor your health.
• How many cases of hepatitis C are reported to the health district each year? On average, two cases of acute hepatitis C are identified each year in Clark County. Most people who become infected with hepatitis C initially have mild or no symptoms and do not know that they have been infected unless they are tested by a doctor. Only a small percentage of people infected with hepatitis C develop acute disease and have any outward signs of infection.
• As a patient, how can I protect myself when getting these types of medical procedures? It is important to remember the transmission of the disease in these cases was not related to the medical procedures, but rather to the anesthesia administered to the patient. When proper injection practices are followed, medical procedures, including colonoscopies or similar procedures, generally are safe. All health care professionals and medical facilities should follow safe injection practices and infection control procedures. Patients can and should ask their medical providers about the practices used in their facility.
• What are the recommendations for people who test positive for hepatitis C, B, or HIV? Options for disease management and possible treatment options, as well as regular health monitoring, should be discussed with a physician who can determine the appropriate next steps for the patient.
The Southern Nevada Health District issued the following questions and answers after launching the largest patient look-back effort in history by contacting 40,000 patients potentially exposed to bloodborne pathogens in a Las Vegas endoscopy clinic:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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