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Hepatitis scare stokes concerns about needles, syringes

BY KEITH HERBERT | keith.herbert@newsday.com

8:32 PM EST, November 24, 2007

Last week, nurse Roseann Nitz got a question from a patient unlike any other she's fielded in two decades.

The patient asked Nitz, who works in an Amityville health clinic, to replace the needle and syringe that the nurse had just prepared in order to give an injection. The patient wanted to watch as a new needle and syringe were taken out of their packaging.

Nitz willingly complied, but said, "I was taken aback. It made me feel like she didn't trust me. I guess we're going to be getting more of that."

The recent alleged practices of Dr. Harvey Finkelstein, a Nassau County anesthesiologist, have spotlighted how essential it is for health care professionals to be scrupulous in procedure and practice.

Finkelstein, linked to the reuse of a syringe and contamination of multi-dose vials, is believed to have caused the infection of at least one of his patients with hepatitis C. State health officials have notified hundreds of Finkelstein's patients that they could be at risk for infectious diseases such as hepatitis B and C and the HIV virus.

Whenever blood is involved, whether a person is undergoing a medical procedure or getting a tattoo, there's the potential for transmission of diseases if instruments are not sterile.

Patients can cut the risk of such transmission by asking key questions before the first drop of medication is drawn, doctors and infectious-disease control specialists interviewed last week said.

"In the old days, you and I wouldn't think to ask those questions," said Dr. William Schaffer, an epidemiologist who works at Vanderbilt University and a board member of the Infectious Disease Society of America. "We would assume that every nurse or doctor is adhering to professional procedures."

Inquiries can be as simple as asking whether doctors or nurses washed their hands before injecting medications, or whether all medical staff members are wearing protective gloves, experts said.

When getting an injection of medication, any patient should ask the health-care professional whether he or she used needles and syringes only once. If the doctor or nurse says they reuse such instruments, "I'd be out of there fast," Schaffer said.

A more detailed question could be whether medication being drawn by a needle and syringe is coming from a single-dose vial -- a factor that in itself reduces the risk of blood-borne disease transmission.

Multi-dose vials of medication, which are at the center of the Finkelstein case, are routinely used in all types of medical care settings, and are safe when proper infection-control procedures are used, experts said.

But if procedures are sloppy, multi-dose vials can become a transmission source to patients who subsequently receive injections.

When multi-dose vials are used, one disease-transmission prevention technique that consumers should watch for is the use of germ-killing alcohol to swab a vial's rubber top before a needle is placed inside the vial.

Just as important as what to ask can be when to ask, said Jackie Rowles, president-elect of the American Association of Nurse Anesthetists and a certified registered nurse anesthetist in Indianapolis.

Rowles recommended getting concerns addressed as soon as possible, before medications are placed on the table.

An ideal time is when a patient is presented with a consent form. Often, as in the case of a flu vaccination, the consent form outlines the risks associated with the injection and possible side effects, and health care professionals expect questions from patients at that time, Rowles said.

Wait much later, and a patient -- especially a person receiving an injection for pain, such as an epidural -- could be lying on his or her stomach and unable to observe medications being drawn into needles and syringes.

Another safety protocol is standard procedure in some, but not all, physicians' practices: the presence of another person in the room when a doctor or other health care professional is preparing medication and an injection is given.

"There has to be someone else in the room to check the sterile technique," Rowles said. "Part of their job is to be a watchdog."