It is thought that thousands of patients may be carrying the hepatitis C virus after they received medical care at a Las Vegas outpatient clinic over the last four years. A Clark County investigation has found the clinic was not using clean syringes for each patient anesthetized there. All six have been diagnosed with acute hepatitis C, a blood-borne infectious disease that infects the liver. Ensuing chronic hepatitis can result in cirrhosis and liver cancer. There is no vaccine against hepatitis C. Investigators have found patients received multiple shots using the same syringe from other patients, dipped back into the vials that allowed infection to spread. Five of the six hepatitis C victims had the procedure on the same day.
Anyone getting an injection from a multiple use vial needs to know how it can happen:
A clean syringe is used to draw sedative from a vial.
- It is then given to a patient previously infected with the hepatitis C virus (HCV). Backflow into the syringe contaminates it with HCV.
- The needle is replaced but the syringe is reused to draw additional sedative from the same vial for the same patient contaminating the vial with HCV.
- A clean needle and syringe are used for a second patient but the contaminated vial is reused. Subsequent patients are at risk for infection.
The Southern Nevada Health District has sent warnings to all patients who visited the clinic, the Endoscopy Center of Nevada. There is a chart in the warning showing the mode of infection.
The problems occurred March 2004 to last January. It is estimated about 40,000 patients visited the clinic.
Brian Labus, senior epidemiologist at the district says this is the way they did things at the clinic. It’s the way they have always done things he tells the New York Times.
The blood borne disease, hepatitis C can remain dormant with no symptoms for many years even while it causes damage to the body. However liver damage, jaundice and fatigue are the symptoms. The disease is generally transmitted by sharing contaminated syringes.
Unsafe infection control is a growing public health problem as a mode to transmit HIV and hepatitis.
Of particular concern are the multi-dose vials common in many medications and vaccines to keep costs down by reducing waste. They are also more likely to spread contamination than single-dose vials.
In New York last year, Dr. Harvey Finkelstein, an anesthesiologist in Nassau County, told health officials that he would reuse a syringe to draw medications for patients from more than one vial. Blood backed up on the used syringe could enter a multi-dose vial, potentially spreading infection when that vial was used again.
In that case, state health officials had to notify more than 600 patients to be tested for hepatitis C.
And in 2002, an outbreak of hepatitis C in a Norman, Oklahoma pain clinic found at least 52 people were infected after a nurse used the same needle and syringe to give drugs to many patients.
Three cases of hepatitis C were traced to a New York City anesthesiologist in 2007 who administered pain medication in the same way.
The CDC reports that healthcare providers or anyone administering injections should never reuse a needle or syringe either from one patient to another or to withdraw medicine from a vial. Both needle and syringe are to be thrown away once they have been used. It is not safe just to change the needle and reuse the syringe.
A multi-dose vial should always have medication withdrawn with a clean syringe and needle.
Whenever possible, CDC recommends that single-use vials be used and that multi-dose vials of medication be assigned to a single patient to reduce the risk of disease transmission.
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