Nassau hospital's call to test injected patients seen as opportunity
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For public health officials, the 4,247 letters South Nassau Communities Hospital recently sent to patients recommending they get tested for hepatitis B and C and HIV after the possible misuse of insulin pens are both disheartening and an opportunity.
"We're aggressively following up after this episode and we're hoping that people notice and ask: 'Is that the right way to do it?' " said Mary Beth Wenger. She is the state Department of Health's representative for the One & Only Campaign, a drive to promote safe injection practices led by the federal Centers for Disease Control and Prevention and a national coalition of advocates and medical groups.
The campaign was started in 2008 after hundreds of cases of hepatitis B and C nationwide were linked to unsafe injection practices. That included Dr. Harvey Finkelstein of Plainview, a pain management doctor who in 2004 was observed reusing syringes in multidose vials, causing at least one transmission of hepatitis C.
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In 2008, Nassau University Medical Center in East Meadow sent out 840 letters to diabetes patients urging them to get tested after nurses reported hearing of other nurses using insulin pens on more than one patient.
Something similar happened at South Nassau, where a nurse was heard saying it was all right to reuse the reservoir that contains insulin -- but not the needle -- in more than one patient, the Oceanside hospital said.
The hospital has said the risk of infection is "extremely low."
Because of potential backflow of blood into the open cartridge after injection, using a pen on multiple patients could expose them to infection, studies have found.
The campaign is trying to make that clear, and its message is straightforward:
"Needles and syringes are single use devices. They should not be used for more than one patient or reused to draw up additional medication. Do not administer medications from a single-dose vial or IV bag to multiple patients. Limit the use of multidose vials and dedicate them to a single patient whenever possible."
Nevertheless, unsafe injection practices remain a problem.
Since 2001, at least 49 outbreaks have occurred because of contaminated injections, the CDC reported last year. Twenty-one of those involved transmission of hepatitis B or C; the other 28 included outbreaks of bacterial infections. They also resulted in about 150,000 patients who had to be notified to undergo testing, the CDC said.
Last year, the Department of Veterans Affairs issued an alert systemwide after the report of insulin pen misuse at its Buffalo hospital. Of 395 patients tested, 18 were found to have hepatitis, a virus that affects the liver.
And a 2010 survey of 5,500 health care professionals found that 1 percent said they reused syringes and 6 percent reused single-dose vials.
Asked why the problem persists, Dr. Melissa Schaefer, a CDC medical officer, said: "We don't feel there is an acceptable reason for this. There is no acceptable reason for unsafe practices."
Wenger said she has heard a range of reasons. "In some cases, it may be poor training or lack of training or you hear 'that's what we learned in school, but when you get into the work world, it's different,' " she said. "We all know the time pressures, and I think sometimes corners may get cut."
But for both, an episode like South Nassau's presents a teachable moment. "As unfortunate as these events are, it's important to learn from others' mistakes," Schaefer said.
THREE QUESTIONS TO ASK
The One & Only Campaign urges patients to ask their health care providers the following before an injection:
-- Will there be a new needle, new syringe and a new vial for this procedure or injection?
-- Can you tell me how you prevent the spread of infections in your facility?
-- What steps are you taking to keep me safe?
SOURCE: The One & Only Campaign