June 11, 2012
At Least Ten People Infected With Hepatitis C—In Exeter, NH Hospital
By Michael D. Shaw
Hepatitis C—caused by an RNA virus that attacks the liver—is the most common chronic blood-borne infection in the United States. Hep C is implicated in 40 percent of all cases of chronic liver disease, and is the leading indication for liver transplant. The most common risk factor is illegal drug use.
In 60 to 85 percent of cases, those acquiring the hep C virus develop a chronic infection. Yet, most sufferers are unaware of their condition, asymptomatic for years, until liver damage is revealed via routine medical tests. Because of the long-term nature of the infection, significant complications may occur, including cirrhosis, liver cancer, and complete liver failure.
Therapy can be expensive and quite unpleasant, so given the circumstances, people are advised that prevention—by avoiding the drug abuse lifestyle—is the most prudent course. That’s fine advice, but there is little prevention that can be exercised against a hep C infection if it is acquired in a hospital, while you’re being treated for something else.
Such is the bad news that was revealed to ten poor souls within the last few days. At first, four patients were discovered, but six more followed in fairly short order. All of the patients were involved with Exeter Hospital’s Cardiac Catheterization Lab and its recovery room. In response, New Hampshire’s Department of Health and Human Services Division of Public Health Services has expanded its initial recommendations to test patients for hepatitis C, who received care at the Cath Lab and its recovery room on or after April 1, 2011, instead of August 1, 2011 through May, 25, 2012. Staff who worked in the Cath Lab going back to September 1, 2011, are also being tested.
According to the hospital, it has contacted all 651 patients that fit this profile.
Local reporter Jason Claffey has been covering the story and was in contact with one of the victims, who told him: “I’m scared. My family is scared, my friends are saddened. It saddens me that I made it through open heart surgery only to be beat down by a virus … I am faced with the fear of more complications or death.”
To gain insight on this outbreak, I spoke with renowned infection control guru, and friend of this column Lawrence Muscarella, PhD. He identified a few possible infection control breach scenarios…
- The reuse of syringes in conjunction with a contaminated multi-dose vial of an IV medication
- The theft, tampering, or so-called “diversion” of an addictive IV narcotic (replacing the drug in its vial with saline)
- Utilizing a contaminated radiopharmaceutical in myocardial perfusion studies
Muscarella noted that this case is eerily reminiscent of Hep C infections attributed to unsafe injection practices at an Endoscopy Clinic in Las Vegas in 2007. He also pointed out that in each of the ten cases, the same strain of the virus is present. That finding certainly strengthens the notion that all of the infections can be attributed to the same source. (As opposed to random infections that may have occurred elsewhere for these patients.)
Interestingly, Exeter Hospital and infection control problems were in the news about one year ago. A story posted on June 20, 2011 entitled “Exeter Hospital settles suit with whistleblower” details the saga of Susan Smith, gastroenterology nurse at the facility. It seems that Nurse Smith uncovered a variety of poor practices between 2006 and 2008, including some serious infection control breaches. She contends that she spoke out about these matters, and was fired for her trouble.
While her settlement with the hospital is sealed, Muscarella believes that the hospital’s insurer would have insisted that the practices she described be corrected. Further speculation would be ill-advised, as we wait for the investigation to play out. Nonetheless, with ten cases so far—within a relatively small cohort—this is a very big deal.