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Injection Safety: Preventing Viral Hepatitis Infections

This presentation focuses on preventing healthcare-associated viral hepatitis infections via injection safety. The presentation discuss resources and recommendations for safe injection and assisted blood glucose monitoring practices.

MI Viral Hepatitis Unit

on 21 November 2013

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Transcript of Injection Safety: Preventing Viral Hepatitis Infections

CDC: Healthcare-associated Infections
Michigan Department of Community Health
Geoff Brousseau
Seth Eckel
Kim Kirkey
Allison Murad
Ambulatory Surgery Centers
Centers for Disease Control and Prevention
Health Care Associated Infections
Injection Safety
Injection Safety: Preventing Viral Hepatitis Infections
Michigan Department of Community Health
Bureau of Disease Control, Prevention, and Epidemiology
HIV/STD/VH/TB Epidemiology Section
Viral Hepatitis Unit

Joseph Coyle, MPH
Viral Hepatitis Unit Manager

Emily Goerge, MPH, MSN, RN
Viral Hepatitis Nurse Consultant

Chardé Fisher, MSW
Viral Hepatitis Prevention Coordinator
Viral Hepatitis
Healthcare Associated Outbreaks
CDC Recommendations Review
Inflammation of the liver
Contact with infectious blood, semen or other bodily fluids
Can progress from acute to chronic illness
Vaccine preventable
Contact with infectious blood
75% of cases progress from acute to chronic illness
No vaccine
Effects of hepatitis
Infections that patients acquire while receiving healthcare treatment for other conditions
The delivery of healthcare has the potential to transmit viral hepatitis to both health care workers and patients
Hepatitis B
1 week or more
Hepatitis C
16 hours up to four days
Improper cleaning of:
Injection Safety
Safe injections DO NOT:
Harm the recipient
Expose the provider to any avoidable risk
Result in waste that is dangerous for the community
Standard Precautions
Improper use of:
Assisted Blood Glucose Monitoring and Insulin Administration
Insulin pens are for single-patient-use ONLY
CDC: Injection Safety
One and Only Campaign
Blood Borne Pathogens
A microorganism found in the blood that can lead to an infection
Hepatitis A Virus
Acute Illness
Ingestion of contaminated food or water
Hepatitis B Virus
Hepatitis C Virus
Care and treatment is expensive
$45,000 - $75,000
Treatment side effects anxiety, depression and insomnia
Stigma, loss of social support and isolation
Hepatitis B and C can be present and infectious without the presence of VISIBLE blood
More cases of a particular disease than expected in a given area, or among a specific group of people, over a particular period of time
Main cause of liver transplants
Leading cause of death from liver disease
Other sharp instruments
Blood glucose meters
Multi-dose medication vials
IV saline bags
Hand hygiene
Personal Protective Equipment
ALL sharps (syringes, needles, razor blades, etc.) are to be disposed of in an approved sharps container.
Aseptic technique
A procedure used by medical staff to prevent the spread of infection by creating an environment that is free from contamination
Medications preparation
Meds should be drawn up in a designated, clean medication area
Cleaning and Disinfecting Equipment
Always follow the manufacturer’s instructions on how to clean the equipment
Infection Control
Whenever possible, blood glucose meters should NOT be shared
One needle, one syringe, one time
Single-dose vials are for use on one patient for one injections only
Do not store leftover contents for later use
Do not combine leftover contents of single-dose vials
Multi-dose vials should NOT be kept or accessed in immediate patient treatment areas:
patient rooms
operating rooms
pre- or post-op

If a multi-dose vial enters the immediate patient care area, it should be dedicated to that patient only and discarded after use
Intravenous bags
Do NOT use bags or bottles of intravenous solution as a common source of supply for more than one patient
Alex Pomar
“When I got that letter about being tested, I said, ‘Oh, my God,’ ”

“When I got to the lab, the place was packed and everybody was talking about what could happen. You could feel the fear.

....I was in my 70s then, kind of a young man, and I was afraid if I had something I could have passed it to my wife. I thought I was going to die.

.... I had to wait a week for the test results. I was going nuts.”
Dr. Dipak Desai
Reused medication vials on multiple patients
Convicted of 27 criminal counts:
Reckless disregard of persons
Neglect of patients
2nd degree murder
Sentenced to life in prison
CDC & Nevada State Health Division Bureau of
Licensure and Certification (BLC)
Risk for exposure:
Reuse of syringes & reuse of medication vials
Henry Chanin
"I turned yellow. My eyes turned yellow. I couldn't' eat. I was throwing up everything they tried to put in me,"
February 2008 patient notification:
Patients from March 2004 to January 2008
Hepatitis B, Hepatitis C, HIV
Approx. 64,000 patients notified
Endoscopy Center of Southern Nevada
Desert Shadow Endoscopy Center (DSEC)
"feeling better, day by day"
"Oh my God, I'm going to die! How could this have happened to me?"
Impact of Outbreaks
Treatment side effects: muscle & joint pain, nausea, headaches, fatigue and loss of appetite
Never use instruments or equipment that have not been properly disinfected
Includes proper handling, preparation, and storage of medications and supplies
Syringes, needles and other sharps should be stored sealed in their original packaging until they are to be used
Sharps Handling
What's wrong with this picture?
Syringes are:
Not in packaging
Stored in a drawer
Used or unused?
Vial is:
Stored in fridge with food
blood as if a blood borne pathogen is present
Southern Nevada Health District (SNHD)
January 2008 acute HCV cluster identified
Patients at Endoscopy Center of Southern Nevada (ECSN)
July & September 2007
Outbreaks impact ALL patients:
Testing stress & anxiety
Living with a chronic illness
9 patients contracted hepatitis C directly linked to ECSN & DSEC
A total of 106 additional HCV possibly linked to the clinics
Ronald Lakeman:
Convicted on 16 ciminal charges
Faces sentence of 15 to 69 years
Keith Mathahs
Pleaded guilty in 2012
Faces 28 to 72 months as part of a deal
Investigator Whiteley:
“Everybody was kind of scared to talk because their professional licenses were on the line, or they were worried about being sued or prosecuted.”
District Attorney Mike Staudaher:
“The jury’s verdict in this case has hopefully sent a message to health providers, from nurses to doctors, that if you compromise patient care and well-being to keep a job or to line your pockets with cash, you will be held accountable.”
James McIntosh:
“I hope it sends a strong message that this sort of behavior won’t be tolerated,” “People have to be held accountable to a certain standard of care.”
Impact on community:
Creates fear and distrust of the entire healthcare system
Increases insurance premiums
Expensive tax funded health department investigations
Hematology/Oncology Clinic, 2001
4 acute hepatitis C cases
All received chemotherapy at common clinic
99 patients tested positive for HCV genotype 3a
Assisted living Facility, 2010
Cluster of acute HBV infections
8 persons newly diagnosed with HBV infection
All received assisted blood glucose monitoring
Exeter Hospital, 2011
Cluster of acute HCV infections
All patients of cardiac catherterization lab
4 infected patients genetically linked
Between 2008 and 2012:
35 health care associated viral hepatitis outbreaks
100,000 patient encouraged to pursue testing for bloodborne pathogens
311 cases of Hepatitis B or C identified
Diversion of fentanyl intended for patient use
Over 12,000 people recommended to pursue HCV testing
42 person in 3 states tested positive for match HCV strain
Fingerstick lancing devices used on multiple patients
Blood glucose monitors not properly disinfected
All 8 cases hospitalized, 6 died from their infections
Syringe reuse
Common source saline bag for multiple patients
Professional licenses revoked
89 lawsuits filed
6 individuals died from HCV infection
Project supported by cooperative agreement 1U51PPS004030-01
75% of HCV infected person do not know they are infected
Indirect costs: time lost from work due to medical appointments
In 2013, Technician pleaded guilty to federal drug theft and tampering charges
The final health and financial impact of this outbreak has yet to be fully realized.
Even one person acquiring hepatitis due to a medical procedure is one too many
Health care associated outbreaks of hepatitis B and C are preventable if everyone follows basic infection control and safe injection practices
ALWAYS, ALWAYS, use a new, sterile syringe and needle to draw up meds
Joseph Coyle, MPH
Viral Hepatitis Unit Manager

Emily Goerge, MPH, MSN, RN
Viral Hepatitis Nurse Consultant

Chardé Fisher, MSW
Viral Hepatitis Prevention Coordinator
ALWAYS perform proper hand hygiene prior to providing patient care
Multi-dose vials should be dedicated to a single patient whenever possible
Living with viral hepatitis can be challenging and overwhelming
Serious liver complications
Severe illness
Lifestyle changes
* CDC recommends all health care providers be vaccinated against Hepatitis B
*In healthcare settings 1 case can be considered an outbreak
NEVER use finger stick devices for more than one person
Full transcript