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Narcotic Drug Diversion Suspected in Hepatitis C Outbreak

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New Hampshire is the latest state gravely impacted by a hepatitis C outbreak, in this case, tied to the cardiac catheterization laboratory (CCL) and recovery area of Exeter Hospital. As of press time, 20 cases had been confirmed – including one hospital employee – from more than 1,000 patients and staff who have been asked to undergo testing. Patients dating back to October 2010 were contacted about the outbreak, although the earliest confirmed case is said to be someone who visited the CCL in September 2011.

Initially, the state's Public Health Director Dr. Jose Montero cited three areas of investigation:

• The hospital’s procedures for preventing infections, managing narcotics and disposing of medications.

• Employee compliance with the hospital guidelines in those areas.

• Hospital narcotics abuse by an employee who then spread the liver disease to patients by using a contaminated syringe.

Last week, a 61-year-old Newmarket woman and Exeter patient who tested positive for hepatitis C filed a lawsuit against the hospital based on its alleged negligence. The retired medical professional states that as a result of her visit to the hospital, she also contracted the antibiotic-resistant infection, Staphylococcus aureus.

According to the woman's attorney, recently the hospital confirmed that she had acquired hepatitis C during her February 2012 hospital treatment at the CCL, and simply advised her to consult her primary care doctor.

There is widespread belief that the source of the hepatitis outbreak is an unidentified hospital employee who used syringes to self-inject stolen narcotics. The syringes were then – unbeknownst to other medical staff – reused on patients.

State officials and authorities are working on the legal aspects of these allegations, while hospital representatives state the suspect employee – who is infected with hepatitis C but reportedly does not have a "direct patient care role" (or necessarily a role in the CCL) – is on leave.

Outside of this latest outbreak, according to information collected by the Centers for Disease Control and Prevention (CDC), in the last 10 years, three different medical facilities across the nation have experienced a hepatitis C outbreak due to narcotics abuse by a medical staff member. In each scenario, an infected employee self-injected stolen fentanyl intended for patient use, replacing it with a used syringe filled with saline. A total of 40 patients contracted hepatitis C in those three combined exposures, out of approximately 13,000 patients notified about the risk.

The CDC reports there have been nearly two dozen incidents in the last decade when hospitals had to notify patients of potential hepatitis B or hepatitis C exposure due to unsafe syringe practices. In the majority of the cases, the initial source in each of the exposures was a patient infected with the virus. These patient infections were commonly transmitted when the same syringe was used to draw medicine from a container multiple times, or the same syringes (or insulin pens) were used on multiple patients.

As an alternative to solely educating healthcare workers, the CDC study recommends the development of new safety features – such as syringes that change color to indicate prior use.

Currently, New Hampshire is one of only four states in the country that does not require physicians to report cases of hepatitis C. New Hampshire has the most liberal policy, not requiring any medical provider to provide information about new hepatitis C cases unless an outbreak is confirmed. Under state law, any "outbreak, cluster of illness, or unusual occurrence of disease" that poses a public health concern must be reported to the state within 24 hours.

As for the other three states, California and Alaska exempt only hospitals from the requirement; whereas North Carolina exempts hospitals and laboratories, but requires reporting from clinics.

In some cases, it can take up to 20 years before someone with the hepatitis C virus becomes symptomatic; and yet, more than 80 percent of those affected go on to develop serious liver complications or other ailments – quite often leading to death.

After the Exeter incident, perhaps this handful of states will reconsider.

Sources

Seacoastonline.com: Newmarket woman sues Exeter Hospital over hepatitis C infection

Bangor Daily News: NH explores drug use by hospital employees in major hepatitis C outbreak

Karen Butler (kbutler@vpico.com) is Editor in Chief of SurgiStrategies.

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