Reuse of needles in clinic sparks HCV outbreak

Case highlights worries about HCV transmission

More than 50 patients were infected with hepatitis C at an Oklahoma pain management clinic when a nurse reused a syringe and needle for injections into a heparin lock of the patients’ IV line. The case, which is still under investigation, represents the largest known nosocomial transmission of hepatitis C in the United States, says Michael Crutcher, MD, state epidemiologist with the Oklahoma State Department of Health in Oklahoma City.

Cross-transmission of hepatitis C through improper procedures is gaining increasing scrutiny nationwide. In Fremont, NE, the state department of health identified 10 patients who became infected at a hospital-based oncology clinic and recommended the testing of more than 600 patients. The American Association of Nurse Anesthetists sent a letter to 33,000 members, students, and hospital administrators, emphasizing the dangers of reusing needles.

In the Oklahoma case, a nurse anesthetist drew medication into a single large syringe and injected it into the IV lines of numerous patients, Crutcher says. The nurse tested negative for hepatitis C. "The hypothesis is that a chronically infected person served as a reservoir of infection for other persons," says Crutcher, who noted that 15 patients also tested positive for hepatitis B. "Once you’ve infected one person, and that person comes back in, [he or she] can serve as a reservoir. It can amplify over a short period of time where you have numerous patients who are infected."

About 600 patients who were treated at the clinic based at Norman Regional Medical Center since 1999 have received letters that recommend testing. The anesthesiologist and nurse anesthetist also worked at two other hospitals in the area, says Karen Carraway, manager of community relations at Norman Regional. They are not employees of the hospital.

The transmission came to light when a local gastroenterologist noticed a cluster of six patients with hepatitis C. Their only commonality: They had all received pain management services from the same anesthesiologist and nurse anesthetist.

When the hospital learned of the cluster, it immediately asked for an investigation by the health department, Carraway says. "The main thing is to keep in mind that we’re here for the patients," she says.

Reports of the needle reuse also prompted an inspection by the U.S. Occupational Safety and Health Administration into needle safety practices.

Norman Regional Medical Center received two citations, but neither related directly to the needle reuse. The hospital was cited for failing to list the type and brand of device on the sharps injury log and failing to update and review the exposure control plan annually.

The update actually had occurred but had not been entered on the hospital’s intranet, and the additional sharps information had been recorded separately, Carraway says. Those issues were abated, and the fine was cut in half, to $562.50 for each citation, she says.

"The person who had used the unsafe needles was not an employee of the hospital; he was self-employed," says Diana Petterson, spokeswoman for the Department of Labor, who notes that the hospital uses safe needle devices.