Written testimony by Evelyn McKnight, AuD
President/Founder, Hepatitis
Outbreaks National Organization for Reform (HONOReform)
415 E 23rd Street, Suite A
Fremont, Nebraska 68025
E-mail: evelyn@honoreform.org
Phone: (402) 721-8960
Submitted on June 17, 2010 to the US House
Committee on
Oversight and Government Reform
2157 Rayburn House Office Building
Washington, DC 20515
"Viral Hepatitis: The Secret
Epidemic"
Mr. Chairman and Members of the Subcommittee:
In the last decade, more than 150,000
patients in the United States were notified of potential exposure to hepatitis
B virus (HBV), HCV, and HIV due to lapses in basic infection control practices
in healthcare settings. The majority of
these cases derive from the re-use of syringes, the misuse of single-dose or
single-use vials, and the re-entry into a multi-dose medication vial or other
infusion containers with a previously used needle and/or syringe. Most recently, a notification was issued to
350 Cerebral palsy patients at Children's Hospital of Pittsburgh. The notification was issued upon learning
that a physician had been reusing syringes on multiple patients to administer
Botox injections over the course of five years.
Earlier this year, 8 patients were confirmed to have contracted HCV
while seeking care in a holistic medical clinic in Brandon, FL. This outbreak occurred when an employee
failed to follow standard procedures for preparing and administering
intravenous therapies.
From coast to coast, no part of this country is immune to such outbreaks. Between 1998 and 2008, there were five
reported outbreaks in outpatient facilities across the state of New York that
resulted in 70 confirmed cases of HBV and HCV transmission. The 2010 report "US Outbreak
Investigations Highlight the Need for Safe Injection Practices and Basic
Infection Control" in the Clinics in
Liver Disease citied the increased prevalence of such outbreaks occurring
the outpatient settings which have less oversight than inpatient
hospitals.
There are measures that can be taken to
combat this growing public health problem.
The authors of the 2009 report "Nonhospital Health Care–Associated
Hepatitis B and C Virus Transmission: United States, 1998–2008", as
published in the Annals of Internal
Medicine, noted that "a comprehensive approach involving better viral
hepatitis surveillance and case investigation, health care provider education
and training, professional oversight, licensing, and public awareness is needed
to ensure that patients are always afforded basic levels of protection against
viral hepatitis transmission." I
believe this comprehensive approach can be implemented across all healthcare
settings to ensure that no other family goes through the pain and confusion
that my family felt after my diagnosis of HCV.
My malpractice litigation took almost four
years. When it ended, my husband, Tom (a
local family physician), and I made the decision to use my settlement award to
establish a nonprofit patient advocacy organization – Hepatitis Outbreaks
National Organization for Reform, or HONOReform. Our efforts are focused on advocating for
comprehensive injection safety reforms at the state and national levels. HONOReform seeks to eliminate healthcare
transmission of hepatitis C and other bloodborne pathogens. This should NEVER occur. We are working to improve oversight and
adherence to best practices, educate healthcare professionals about
evidence-based guidelines they can use to create a safer environment for their
patients, and inform the public about the serious threats posed by improper
injection safety practices, especially in ambulatory care settings.
When I first learned of my diagnosis, I was
mad, scared, and in search of answers. I
confronted a number of challenges along the way including living with chronic HCV
– which for me is analogous to having the flu each day of my life. I endured hurtful and untrue stigmas
associated with my condition.
When I share the story about what has
happened to me and thousand of other Americans, most people react by asking me,
"Isn't this Nursing 101?" Don't all physicians and nurses know not to do this? The answer, as we now know, is that "No, basic safe injection practices are
not understood and applied across healthcare practices." This must and will change. With the migration of care from the hospital
to the nonhospital setting coupled with the rise in baby boomers with hepatitis
seeking healthcare for preventive services, I am afraid these outbreaks will
continue to occur. HONOReform
established a three-pronged policy platform to address specific areas of
improving patient safety.
Safety by
Incentives – In order to ensure health care providers follow the necessary
precautions and protocols to ensure the patient's safety is put first in any
health care setting, there must be appropriate mechanisms and incentives in
place to guide health care workers.
Safety by
Design – Improve the safety of our current system by implementing system
change to ensure mistake proofing changes are made in the physical design of
healthcare processes and by reducing human error.
Safety by
Culture and Empowerment – Through education, outreach, and grassroots
initiatives,
influence
the culture of patient safety.
Over the few years, HONOReform has been
collaborating closely with many different entities around the issue of
healthcare transmission of hepatitis C, hepatitis B, and HIV. Together with the Centers for Disease Control
and Prevention (CDC), we have formed the Safe Injection Practices Coalition. This coalition of stakeholders, including
healthcare providers, industry partners, and patient advocates, created the One & Only Campaign focused on
providing education and awareness to patients and healthcare providers about
safe injection practices.
Sadly, the root causes underlying these outbreaks of hepatitis B, hepatitis C,
HIV, and other blood-borne diseases appear to be a lack of adherence to basic
safe practices (you never re-use a syringe), combined with a sobering,
misguided attempt to save time and pennies at the margin at the risk of
patients' lives.
In June 2007, the CDC and the Healthcare
Infection Control Practices Advisory Committee (HICPAC) updated and released
their Guidelines for Isolation Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings.
The guidelines take into account the fact that over the last 25 years
healthcare services have migrated from hospitals to outpatient ambulatory care
facilities. The CDC Guidelines are quite
clear when it comes to injection safety.
However, these straightforward guidelines are routinely not adhered to
in outpatient facilities and private physicians' offices. Simply stated, the Guidelines affirm the
following:
1) Use
aseptic techniques to avoid contamination of sterile injection equipment;
2) Use single-dose
vials for parenteral medications whenever possible;
3) Recognize
that needles, cannulae and syringes are sterile, single-use items and should
not be reused for another patient nor to access a medication or solutions that
might be used for a subsequent patient; and
4) Do not
use bags or bottles of Intravenous solution as a common source of supply for
multiple patients.
I close with the hope that no more patients
will receive a letter like the more than 150,000 Americans, and the one letter
I received informing me that I have contacted hepatitis due to the simple act
of seeking healthcare from a licensed oncologist for my breast cancer
treatment. Healthcare should not be a high-risk behavior. When considering a comprehensive
approach to address the hepatitis
epidemic, I urge the Committee to address the issue of healthcare transmission
of hepatitis as a major contributor to the rise in incident of hepatitis across
the country.
Thank you for the opportunity to submit
written comments. I look forward to
working with all of you in the weeks, months, and years ahead as we move to
save lives and ensure patient safety by preventing the spread of hepatitis in
healthcare settings.