Endoscopy Center of Southern Nevada: 4 years of reused syringes, 40000 at risk of HIV

[MSD]

... Plus all strains of Hepatitis.
http://www.lvrj.com/news/16067972.html (click for full article)

Forty thousand Nevadans soon will receive word that they might have been exposed to HIV and hepatitis strains B and C in what a federal health official called the largest notification of its kind in U.S. history.

Patients who visited the Endoscopy Center of Southern Nevada at 700 Shadow Lane between March 2004 and Jan. 11 are being urged to get tested for the diseases as soon as possible.

Health officials cautioned them to practice safe sex and use condoms.

At a Wednesday afternoon news conference attended by health officials and doctors from the facility, officials said six people diagnosed with acute hepatitis C in recent months received treatment at the center near Valley Hospital Medical Center. They are believed to have been exposed to the disease when anesthesiologists reused syringes to administer medications.

The Endoscopy Center of Southern Nevada is a high-volume gastrointestinal practice where colonoscopies are frequently performed. Reuse of syringes and vials at the facility was a "common practice" undertaken by everyone from doctors to technicians, health officials said.

The business was investigated for other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.

The medical facility was open for business Wednesday. It could be subject to sanctions or lose its Medicare contract at a later date, state health officials said.

Dr. Eladio Carrera, a gastroenterologist and internal medicine physician at the center, attended the news conference, but he did not address why he and other staffers did not follow correct medical procedures. In a statement, he expressed concern for patients, then refused to take questions.

Dr. Dipak Desai, the center's administrator, was not at the news event and could not be reached later at the office for comment.

As of now, the clinic has been shut down indefinitely and their license has been revoked. It doesn't even look like it was a case of one or two employees not knowing that it's unsafe to reuse a syringe with a different needle.

I understand the mentality of "the rules don't apply to me," it's pretty much my philosophy in life, but even I can't wrap my mind around how someone could think it's acceptable to reuse single-use equipment. I know very little about medical equipment, but it seems intuitive to me that even autoclaving the syringes and using fresh needles is risky. Isn't it common practice to put protective covers on anything that goes into the body, throw away anything that pokes holes in people, and sterilize absolutely everything? What could motivate this kind of thing as accepted practice? Laziness? Cost?

I hope that at the very least, everyone involved is barred from working in any sort of medical occupation, and charged with reckless endangerment and whatever else can be applied if anyone did get sick. If we can't trust our doctors, who can we trust?

edit: according to someone on Something Awful says that local news places in the area are now saying it's more likely that only 3000 are at risk, but that dozens are confirmed to have been infected with Hepatitis. This is fucked up.

[girldetective]

This is stunning. It infuriates me and Im bound to go off on a tangent with the next person I see. I just don't understand it. Why dont people think beyond the moment, the money, or themselves? It is so very fucked up.

And another thing - Whether it is 40000, 3000 or 1 person affected, it is too many. Disposable syringes are very cheap to buy and they are extremely easy to use. They are after all disposable.

[JustJess]

Holy crap. You know, when you learn sterile technique, you're not even allowed to move your hands beyond the tits-to-hips area, or you're not sterile... touch the wrong edge of the blue field, and you're done... etc. It's pretty exacting. I can't even imagine the leap it took to allow this kind of cost-cutting bullshit, but I guess when your only concern is your wallet and not the patient...

Holy crap.

[genuinegirly]

This is so entirely wrong, I don't know where to begin. I guess I'll just quote a guy interviewed at the end of the article.

Angelo Dominic, age 76:

Why can't these people care about other people? Where do they come from?

[blahblah454]

That is pretty frightening. I don't know what I would do if I went in to get a test for colon cancer and ended up with AIDs. Probably sue like crazy and hope to set my family up for life, as I would be dead in 8 years.

[Fotzlid]

The article doesn't mention how they re-used the syringes and vials. Although I'm not condoning the practice, it does make a hugh difference on risk of exposure.
I also don't know how they do the procedures in Nevada, but around here they do something called conscious sedation. An IV is started, fluids are hung and medications are pushed through the IV tubing to make you drowsy but still awake. If the reused sryinges were used to push meds through the tubing, the risk is non-existant for HIV or Hepititis so long as blood didn't get drawn back up in the tubing. If they were giving the patients IM injections (sticking them with needles) with re-used syringes, that is a whole different ballgame.
Re-using vials could be just not opening a new vial if any meds were left over from the previous patient. Since the meds used are controlled substances, I don't doubt the DEA will be looking into that as well as the insurance companies to make sure they weren't charged for a full vial per patient if they were using "left over" meds.
Again, not condoning the practice just pointing out the risk factors.

As far as not cleaning the colonoscopy equiptment properly, that is just plain nasty.

[highthief]

If someone does die as a result of this deliberate and systematic misuse of the equipment, charge the people running the joint with manslaughter.

This is nuts.

[Hain]

Anyone correct me if I am wrong: just from my experiences in chemical fields, would it not have been cheaper to buy the goddamned disposable needles instead of sterilizing them?

How the fuck did the staff get convinced to go along with this?

There's a bad moon on the rise.

[Ustwo]

Health officials said Wednesday evening they don't believe the hepatitis C cases are the result of colonoscopies or gastroenterology procedures performed at the center, though the state licensing board referenced in its report problems arising from these procedures that could spread infection.

Lets put this more into perspective.

They had a outbreak of hep C. One of the things you epidemiology wise is look for common links. This was one of those links. They investigate and find some procedures are not up to code with universal precautions, and it blows up as a story far greater than it should be.

The picture TFPers are giving here is some sort of gross negligence, when it is most likely far less serious, malicious, or stupid than that.

Now I'm not giving these people a pass either, but one news story alone shouldn't create an outrage without more facts on what exactly was done, how it was done, how long it was done for, and who was responsible are unknown.

[snowy]

Originally Posted by Ustwo

Health officials said Wednesday evening they don't believe the hepatitis C cases are the result of colonoscopies or gastroenterology procedures performed at the center, though the state licensing board referenced in its report problems arising from these procedures that could spread infection.

Lets put this more into perspective.

They had a outbreak of hep C. One of the things you epidemiology wise is look for common links. This was one of those links. They investigate and find some procedures are not up to code with universal precautions, and it blows up as a story far greater than it should be.

The picture TFPers are giving here is some sort of gross negligence, when it is most likely far less serious, malicious, or stupid than that.

Now I'm not giving these people a pass either, but one news story alone shouldn't create an outrage without more facts on what exactly was done, how it was done, how long it was done for, and who was responsible are unknown.

Well, it's not just one news story.

http://news.bbc.co.uk/2/hi/americas/7269800.stm has a better explanation of what is thought to have happened in the case of the patients who contracted hep C.

As many as 40,000 people who used a Las Vegas clinic are being urged to be tested for HIV and the blood-borne hepatitis C virus, US officials say.

Anyone who received anaesthesia injections from the Endoscopy Center of Southern Nevada from March 2004 to January 2008 should be tested.

The warning came after an investigation found the centre had been responsible for "unsafe injection practices".

Hepatitis C can cause fatal liver problems and is very hard to treat.

People with the infection can pass it on if their blood gets under the skin or into the bloodstream of another person, for example through the use of a shared syringe.

Contaminated vial

The Southern Nevada Health District announced on Wednesday that it had identified six cases of hepatitis C at the clinic, five of which stemmed from procedures on the same day in September involving anaesthesia.

The sixth patient is believed to have been infected in July, the health district said.

Following an investigation, the district determined that "unsafe injection practices related to the administration of anaesthesia medication might have exposed patients to the blood of other patients".

It said a syringe that was used to administer anaesthetics to one patient may have contaminated the vial from which the anaesthetics were drawn.

The vial, which was not intended for use on multiple patients, was subsequently reused. If the vial was contaminated with hepatitis C, it could have exposed others to the blood-borne pathogens such as hepatitis C, it added.

The district said it was advising patients to contact their doctors and get tested for hepatitis C, hepatitis B and HIV.

The Endoscopy Center said in a statement that it had now changed its practices.

"All concerns noted by the health department were addressed immediately. We want to be sure that every patient who may have been exposed is informed and tested," it said.

[Ustwo]

Originally Posted by onesnowyowl

Well, it's not just one news story.

http://news.bbc.co.uk/2/hi/americas/7269800.stm has a better explanation of what is thought to have happened in the case of the patients who contracted hep C.

Normally one copies another copies another copies another. Its the downside of the current news cycle system.

Again, not giving a pass, but more information is needed before I'd throw them to the wolves.

And if anything the BBC story is less inflammatory...

It said a syringe that was used to administer anaesthetics to one patient may have contaminated the vial from which the anaesthetics were drawn.

Unless they are double dipping, then there really was no cross contamination. You would have to inject someone then use the vial AGAIN with that same needle and then do it with the same vial on another patient and its really not clear. From this I would gather they were reusing single use vials, not needles and I don't know enough of how they do the anaesthetic to say if it would be normal to get a second dose from the same patient.

[JustJess]

I read the rest of the article - you're right in that there is small risk of actual exposure, but allow me to explain some techniques of IV catheterization.

You put in the catheter (basically a plastic tube) with a needle, and connect it to the IV tubing to the bags of solution you're infusing the patient with. There is always a flashback of blood (if you do it right, that is) when you first stick the pt, and to make sure your IV hasn't fallen out of place, you drop the IV bag to see if the blood comes back down the tube. It goes back down into the patient when you replace the IV bag above the level of their arm. So there's a little bit of possible blood/plasma in the tubing. Certainly you'd never reuse that, and the article doesn't claim that they are.

The next thing that often happens is that the anesthesiologist will inject medication from a vial - some kind of anesthetic, either the paralytic or the sedative - into a port on the IV tubing. So that's using a syringe, and there's possible contamination from products in the tubing, so no one ever re-uses that syringe - even on the same patient, just in case it was contaminated at some other point. Plus, that syringe also has whatever else was in the tubing on it, which could contaminate whatever you use it next on. (Medications, etc., not just blood.)

Now, you CAN reuse that vial. You just wipe off the top of it with an alcohol wipe. BUT it must be with a brand new syringe, not with something "re-sterilized" as mentioned in the article. You re-use the syringe, you've now contaminated the vial, and anyone else you use that vial for afterwards. It would be okay to re-use the vial with that patient, and maybe even for other patients, but you'd still wipe it off every time with an alcohol pad, and it's always poor practice to use the same syringe even on the same patient. I can see budget poor hospitals doing it... this place doesn't seem to have any budgetary concerns.

So the risks are certainly lower than if they were using one syringe on one patient directly in their arm, and then "sterilizing" it and using it on another patient directly in their arm; however, it's still not safe, and not good practice at all.

As for the poor cleaning of colonoscopy equipment: your GI tract is full of nasty stuff and will never be considered a clean surgery. But again, you can give one patient someone else's GI infection by not properly cleaning the equipment each time. Or cause an infection/inflammatory reaction just because their system doesn't have the same organisms etc as another person's.

The whole thing stinks of laziness and money-grubbing.

[whatever1]

You cant argue with Ustwo, he knows EVERYTHING about EVERYTHING and is always right, or so he will tell you.

[Ustwo]

Originally Posted by whatever1

You cant argue with Ustwo, he knows EVERYTHING about EVERYTHING and is always right, or so he will tell you.

QFT.

[MSD]

Originally Posted by Fotzlid

The article doesn't mention how they re-used the syringes and vials. Although I'm not condoning the practice, it does make a huge difference on risk of exposure.

They're saying that as many as a few dozen have tested positive, and employees said it was common to reuse all syringes.

Originally Posted by Ustwo

Unless they are double dipping, then there really was no cross contamination. You would have to inject someone then use the vial AGAIN with that same needle and then do it with the same vial on another patient and its really not clear. From this I would gather they were reusing single use vials, not needles and I don't know enough of how they do the anaesthetic to say if it would be normal to get a second dose from the same patient.

It looks like they may have changed needles but reused syringes with the vials, which seems to pose a much smaller but not nonexistent risk of infection.

Originally Posted by whatever1

You cant argue with Ustwo, he knows EVERYTHING about EVERYTHING and is always right, or so he will tell you.

And this certainly isn't trolling or flaming
Since he's the one who went to medical school, I'll trust him on this one.

[pig]

Sometimes I love Ustwo. This is one of those times. Hats off my friend

[Fotzlid]

They're saying that as many as a few dozen have tested positive, and employees said it was common to reuse all syringes.

That in and of itself doen't mean that was the source of contamination. The article glossed right over the probable real cause, not cleaning the scope equiptment properly.
Not too suprising though. Everyone is afraid of needles. Easier villan for the story.

You put in the catheter (basically a plastic tube) with a needle, and connect it to the IV tubing to the bags of solution you're infusing the patient with. There is always a flashback of blood (if you do it right, that is) when you first stick the pt, and to make sure your IV hasn't fallen out of place, you drop the IV bag to see if the blood comes back down the tube.

Dropping the bag down is completely unnecessary. If you get in the vein, there will be a good flashback in the IV needle. When the needle gets retracted blood will come pouring out if you don't have pressure on the vein while you hook up the IV tubing.

[JustJess]

^^ True enough. The drop is just extra assurance that you haven't screwed it up putting on the heplock and IV tubing... and even without it, it's technically possible to have blood products within the tubing, though gravity does work against that... like I said, it's just technically possible.

[pig]

dangit jess: i was all hoping for a serious-ass medicalperson thread fight. alas! my hopes have been dashed! Egad!!!