Having a medical procedure should be safer than getting a tattoo.
My home state of New Hampshire was recently rocked by the
news that 31 patients at a NH hospital had been infected with hepatitis while
undergoing cardiac catheterization, an invasive procedure used to identify
heart disease and defects. Specifically, they tested positive for Hepatitis C,
a viral infection transmitted through blood that results in liver inflammation
and can result in ongoing health issues. The threat of hepatitis transmission
is used to discourage people from getting a tattoo or using intravenous drugs. It’s not something that’s expected as a result
of a hospital procedure.
When I first heard this, I theorized the problem was due to
inadequately sterilized equipment. It’s
no secret to those in healthcare that many invasive medical instruments are
re-used and cleaned between patients. Improper instrument cleaning was blamed in
March 2009 when the Veterans Affair department confirmed that ten patients
tested positive for hepatitis following colonoscopies. Even supposedly sterile,
one-time use equipment has been implicated in disease transmission in the
healthcare setting. Infections from the
use of urinary catheters, central lines, and mechanical ventilators occur with
enough frequency that healthcare facilities enact policies and procedures
designed to lessen the risk. In New Hampshire, hospitals self-report and post data
on health care associated infections. Yes,
being the recipient of health care is a dangerous business.
Though improper cleaning can be attributed to the pace of
healthcare (decreased numbers of staff with less training and an increased
workload) or financial constraints (doing things right costs money, doing them
quickly, not so much), the cause of the Exeter Hospital hepatitis outbreak isn’t
substandard cleaning, rather it’s drug
diversion. The theory being that a healthcare worker with an addiction to
narcotics took the opportunity presented by multiuse vials and/or medication
syringes that are filled but not given immediately, to inject a little for him
or herself. In the process, the infectged
addict spread the hepatitis virus and now 31 people have a chronic liver
disease. This shouldn’t come as a huge
surprise to anyone. It’s not as if
spreading disease through reused syringes and supplies is new.
In 2009 at Rose Medical Center in Colorado at least 18
people contracted hepatitis when a drug addicted scrub tech switched out her
used saline-filled syringes with drug-filled ones prepared for surgical
patients. An outpatient clinic radiology
tech in Florida infected five patients while diverting fentanyl (a potent
narcotic) for his/her own use. Like any
other crime, the ones who get caught are only the tip of the iceberg.
The Centers for Disease Control (CDC) report from 2008-2011
(http://www.cdc.gov/hepatitis/statistics/healthcareoutbreaktable.htm)
attributes outbreaks of hepatitis at outpatient clinics to the use of
contaminated syringes to re- enter single use and multi-dose vials, the use of
single use vials for multiple patients, and drug diversion by healthcare workers
infected with hepatitis. Obviously in
today’s healthcare environment the patient can’t depend on their healthcare
worker doing the right thing (follow strict infection practices) or the
facility doing the right thing (random drug testing, especially of hospital
staff that handle medications in areas known to be associated with diversion). Seems like the concept of do no harm doesn’t apply
to hepatitis prevention.
If the victims of Exeter Hospital went to the CDC FAQ on
Hepatitis C they’d see their risk factor for contracting hepatitis as “sharing
needles, syringes, or other equipment to inject drugs.” Unfortunately, the victims didn’t make the
choice to share, the healthcare worker did. The site also cautions: “A few
major research studies have not shown Hepatitis C to be spread through
licensed, commercial tattooing facilities. However, transmission of Hepatitis C
(and other infectious diseases) is possible when poor infection-control
practices are used during tattooing or piercing.”
Perhaps it’s time to add “transmission of Hepatitis C (and
other infectious disease) is possible when poor infection-control and drug
control practices are used in hospitals and other healthcare settings.”
Until healthcare deals with this dirty little problem, it
may be safer to get a tattoo than a medical procedure.
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