Risky Business?

HCV transmission scares in healthcare settings cause concern

by Larry Buhl

[dropcap]I[/dropcap]n February, Swedish Medical Center in Englewood, Colorado, revealed that it told nearly 3,000 former surgery patients that they should get tested for hepatitis B, hepatitis C, and HIV after it found out a former employee may have exposed patients to these three viruses.

The hospital did not say how the patients could have been put at risk. It also said it had no evidence of any patient exposure to the viruses but wanted to err on the side of caution.

In January, Baystate Noble Hospital in Springfield, Massachusetts, began notifying colonoscopy patients that the equipment might not have been properly disinfected. The hospital said that 293 patients who had colonoscopies at Noble between June 2012 and April 2013 could have been exposed to hepatitis and HIV during their procedures.

In 2013, Buffalo VA Center in Buffalo, New York, said the hospital may have exposed more than 700 of its patients to HIV, hepatitis B, or hepatitis C by mistakenly reusing its insulin pens.

In 2010 John Cochran VA Medical Center in St. Louis, Missouri, notified nearly 2,000 veterans that they were at risk of contracting hepatitis B, hepatitis C and HIV after visiting the medical center for dental work during a thirteen-month period. The VA told local media that health authorities found the problem during a routine inspection.

These HCV and HIV scares in healthcare settings raise the question: How risky are hospitals and nonhospital medical settings?

The U.S. Centers for Disease Control and Prevention (CDC) says that as long as standard precautions and other infection control practices are consistently used, medical and dental procedures generally do not pose a risk for the spread of HCV.

Those standard precautions include using clean, non-sterile gloves, wearing fluid-resistant gowns, wearing a face mask when there’s a risk of respiratory secretions, eye protection or face masks when there’s a potential for splashing of bodily fluids, washing hands for twenty minutes with soap after any patient contact, and strict injection safety procedures. The CDC says the small number of occurrences of HCV transmissions in healthcare settings mostly came from accidental needle sticks, and primarily infecting the healthcare worker. The hepatitis C virus is spread from blood-to-blood contact.

In the U.S. the risk is very low for contracting hepatitis C (or hepatitis B or HIV) while undergoing medical procedures at a nonhospital medical setting. However there is some evidence that health scares based on unsafe procedures at freestanding clinics for colonoscopies and dialysis is increasing.
There were forty-four outbreaks (consisting of two or more cases) of viral hepatitis related to healthcare transmission reported to CDC during 2008-2014. Of those outbreaks, forty-two (ninety-five percent) occurred in nonhospital settings.

But those statistics might not quell anxiety, even when all patients are cleared from possible exposure to infectious diseases, like 12,000 pediatric patients at risk from improperly reprocessed surgical instruments at the Seattle Children’s Hospital in 2015, none of whom have tested positive for HIV or hepatitis so far.

And the publication of a new study of standard precautions for infection prevention, published in the January, 2016 issue of the American Journal of Infection Control (APIC), is raising some concerns as well. That study showed fewer than one in five nurses comply with standard safety precautions.
Researchers from Northwell Health surveyed 116 ambulatory care nurses to measure self-reported compliance with standard precautions, knowledge of the hepatitis C virus (HCV), and behavioral factors influencing compliance.

The survey found that nurses complied with standard safety procedures in these percentages:

• always wearing gloves (ninety-two percent)
• always wearing a face mask (seventy percent)
• always washing hands after removing gloves (sixty-three percent)

“Self-reported data might be an overestimate of actual compliance and that makes these results of particular concern for potential exposure to bloodborne diseases,” concluded the study authors.

The survey also showed that nurses’ knowledge of HCV varied. More than a quarter of nurses (twenty-six percent) believed, incorrectly, that HCV is typically spread through sexual contact, twelve percent didn’t know HCV antibodies could be present without an infection, and eleven percent didn’t know about multiple HCV genotypes.

The authors also say that ambulatory care nurses who choose to implement some safety behaviors and not others is more likely to put them at risk for acquiring a bloodborne infection than other patients. Besides the low risk of infecting patients with improperly sterilized equipment or lax safety procedures, there is a much higher risk of lawsuits for healthcare facilities.


Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles.