NV looks at oversight for surgery centers

Bills would require infection preventionist

In the wake of a highly publicized outbreak of the hepatitis C virus (HCV) in Las Vegas, proposed state laws in Nevada include proposals to hire infection preventionists (IPs) as consultants to oversee practice in freestanding centers.

"It's possible that we could have that sort of requirement within the state of Nevada," says Brian Labus, MPH, a lead investigator in the case for the Southern Nevada Health District in Las Vegas. "We have had those sorts of discussions with the [state] Legislative Committee on Healthcare. Our legislature meets every other year, and they will be meeting again in the spring of 2009."

With another recent HCV outbreak reported in a North Carolina cardiology practice, there is growing sentiment that something must be done to beef up infection prevention oversight in ambulatory care. Whether it involves IPs or some other approach such as increased health department inspections, the aftermath of the Vegas outbreak is expected to set the tone — and possibly the legislative model — for the rest of the nation.

"Nevada must be in the forefront," says William Schaffner, MD, chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville. "They are grappling not only with what happened in the past, but dealing with this going forward. They might be in a position to instruct us all."

Infection prevention oversight might come in the form of a consulting role for an infection control specialist, a state resource, or an infection reporting system through licensure, some sources say.

A "half-dozen" bills are being drafted in Nevada for consideration at the legislative session, but the specifics still are being hammered out, Labus notes.

"Something needs to be done after our large outbreak here," he says. "We're hoping it could serve as a model for other communities. At this point, we will have to see how the legislature wants to move on it. There will be a lot of discussion. [The involvement of IPs] is something that was discussed, and it is a strong possibility for the upcoming session."

The outbreak resulted in the largest look-back investigation in medical history, with some 50,000 patients seen at one endoscopy clinic and 13,000 at another advised to be tested for HCV, HIV and hepatitis B. The practices under investigation in Nevada include alleged reuse of syringes and re-entry into single-dose vials of pain medication for different patients undergoing colonoscopies. A total of 114 cases have been linked to the two clinics, according to Associated Press (AP).1 The health district has not attributed any deaths to the outbreak, but the widow of a former patient has filed a lawsuit blaming her husband's hepatitis C diagnosis and death in 2006, at age 60, on unsafe medical practices, the AP says. Former clinic owners face more than 120 lawsuits that allege medical negligence and a class-action lawsuit by patients who weren't made ill but claim emotional distress, according to AP.

The legislative activity in Nevada could result in similar bills elsewhere. "How to provide the oversight is something that needs to be debated at the national and state level," Schaffner says. "They could require these institutions for licensure to demonstrate that they have an association with some sort of infection control activity. Something that would do immediately is create a new industry of infection prevention consultants."


  1. Ritter K. Nev. agency links 114 hepatitis cases to 2 clinics. Associated Press. Oct. 23, 2008.