Policy, engineering and educational efforts

  • November 29, 2016

Asking your support for HONOReform

Asking for your support for HONOReform
Dr Tom McKnight asks for your support

Thank you for your interest in the work of HONOReform – the only organization dedicated to advancing injection safety. I am asking today for your support of our life-saving work.

Why do we advocate for injection safety?

You will be interested in this story about what happened in my family practice clinic recently that illustrates why we must – together – continue educating healthcare providers and patients about the critical need for injection safety.

My clinic scheduled an assessment by the CDC Nebraska Infection Control Assessment program team. These hard-working nurses and infection preventionists spent a day assessing our clinic’s policies and procedures, making sure that we are doing everything we can to prevent our patients from contracting disease while in our office.

At the end of the day, the assessment team sat down with us to give us their report. Fortunately, we are doing most things right.

But there was one thing that needed improvement. The team found an opened, unlabeled vial of lidocaine in a patient care area. Since the vial had not been disposed of properly, there was a risk that it could be reused improperly, potentially spreading disease.

How do we advance injection safety?

You probaby know that my wife contracted Hepatitis C through unsafe injection practices sixteen years ago. Since then, it is my personal crusade to educate about injection safety. I preach to doctors, nurses and medical students that it is never okay to reuse syringes, needles, medication vials or other medical equipment intended for one time use. But despite my efforts, an unsafe injection could have taken place, even in my own office. In 2016, HONOReform gave educational presentations to 2208 people as well as reaching thousands through social media and virtual audiences. Everyone who has been touched by the retelling of our story joins me in thanking you for your generous partnership and support. We are committed to educating about and advocating for injection safety with every possible opportunity, to keep you and your family safe when you access healthcare.

But even with all our efforts to educate about injection safety, there were eight outbreak investigations of disease transmission through unsafe injection practices in 2016, affecting thousands of Americans! Together we must work even harder to advance injection safety.

Here is how you can spread the word about injection safety

Talk to your healthcare providers about how they are keeping you safe through careful adherence to injection safety guidelines. Pass along HONOReform’s eagerness to provider a quality educational presentation to their professional organization. Here is a useful link: HONOReform’s educational presentation program.

asking for your support for HONOReform

Today I am asking for your support for HONOReform. Your contributions enable HONOReform to educate about the absoulte necessity of injection safety to keep healthcare safe for thousands. Click this “Help Save Lives” link to reach our website to make your gift.

Thank you for your consideration. I hope to hear from you soon.

Sincerely yours,


Thomas A. McKnight, MD
HONOReform Foundation

PS Thanks for helping with this important need. Please donate today to help with our educational efforts.

  • November 21, 2016

Viral Hepatitis Immunization for Children

Viral hepatitis immunization

Today we share information about immunizations for children, especially viral hepatitis immunization. We are grateful to Carrington College for developing the infographic about immunizations for children.



A deadly infection of the liver, hepatitis can eventually lead to cirrhosis, liver cancer, and other dangerous conditions. Viral hepatitis Immunization is available for some types of hepatitis, but not for all.

Hepatitis A

Typically spread by close personal contact, hepatitis A does not result in chronic infection. However, its symptoms can be quite severe, so early vaccination is important. As laid out below in the child immunization guide created by Carrington College, children between 12 and 23 months old receive multiple doses of the vaccine, with doses separated by at least 6 months.

Hepatitis B

The symptoms for hepatitis B are virtually identical to those associated with hepatitis A. Unfortunately, hepatitis B can also lead to chronic suffering. According to the recommended childhood vaccination schedule, the first dose of the hepatitis B vaccine is typically administered within 24 hours of a child’s birth. Further doses will be giver over the next 18 months.

Hepatitis C

There is currently no vaccine available for hepatitis C, although researchers are working hard to change that – possibly in conjunction with an HIV/AIDS vaccine. Full prevention is not possible without a vaccine, but experts at WebMD advise that those worried about contracting the disease avoid direct exposure to blood, practice safe sex, and not share needles with others.

Prevention is important for all types of diseases, especially for infections like hepatitis that can cause years of discomfort. Children and young adults can secure adequate protection through immunization. While injection safety is a concern as hepatitis shots can spread bloodborne diseases, the recent adoption of smart syringes (with features that prevent re-use) promises to reduce the risk of vaccine-related infection.

viral hepatitis immunization


Make sure your flu shot clinic follows injection safety standards!

flu shot clinic resources
Its flu shot season! Make sure the flu shot clinic follows injection safety guidelines

All of us have had experience with the flu – body aches, fever, headache, fatigue, sore throat and runny nose and disruption to normal life. Having the flu can result in a personal minor annoyance or in a major health crisis. The CDC urges everyone six months old and older to receive a yearly flu vaccination. But where should you get your flu shot? There are many places to get your flu shot, ranging from your personal physician’s office to “pop-up” flu shot clinics in public places such as airports and hospitals. Make sure that that the flu shot clinic adheres to injection safety standards. Ask if the organization that is providing the flu shot has taken the pledge for vaccination clinics. Share this checklist of best practices for vaccination clinics with your flu shot providers.

When you share these resources, you may be preventing transmission of disease for yourself and others! Kudos to the Influenza Workgroup of the National Adult and Influenza Immunization Summit for developing these important resources for safety during flu shot season.


Eliminating Viral Hepatitis

Tom & Evelyn McKnight
Tom & Evelyn McKnight

“Ev, you have Hepatitis C. The lab test is postive, but I have no idea how you got it.”

My husband Tom said these words to me on February 8, 2002. And thus began my life with Hepatitis C.

Months later we learned that I contracted Hepatitis C through reuse of syringes during chemotherapy. The oncology nurse drew blood from my port, put the blood in lab collection vials and then used the same syringe to access a large saline bag. That same saline bag had been contaminated with a Hepatitis C+ patient’s blood during his port flush. In all, 99 people who were engaged in the fight of their lives to overcome cancer were infected with this second deadly disease.

I’ve learned alot about Hepatitis C since then. Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.

Recently we celebrated World Hepatitis Day. It is a day to remember those who have died from the disease, support those who currently have it, and work towards prevention. The theme for this year is “Elimination.” The World Health Organization announced a strategy for dealing with the world-wide epidemic of viral hepatitis.

This new WHO strategy introduces the first-ever global targets for the elimination of Hepatitis B and Hepatitis C as public health threats. These targets include a 30% reduction in new cases of hepatitis B and hepatitis C, and a 10% reduction in mortality by 2020, and ultimately achieving even greater health impact by 2030. Key approaches to achieving these targets include:

  • expanding vaccination programs for hepatitis B;
  • preventing mother-to-child transmission of hepatitis B;
  • improving injection, blood, and surgical safety;
  • providing harm reduction services for people who inject drugs; and
  • increasing access to diagnosis and treatment for hepatitis B and hepatitis C.

These are lofty goals, but so necessary.

I am one of the lucky ones. After exhausting treatment, I have no detectable virus in my bloodstream. I am profoundly grateful. I choose to live my gratitude by advocating for safe injection practices so that no one else will hear the words, “You have Hepatitis C, but we have no idea how you got it.”

Think NoHep this World Hepatitis Day


Today is World Hepatitis Day and this year’s theme is “Elimination.” The World Health Organization (WHO) recently adopted the first ever Elimination Strategy for Viral Hepatitis that calls for “rigorous application of universal precautions for all invasive medical interventions and promotion of injection safety measures…”

World Hepatitis Day is a great way to raise awareness about injection safety. Here are six ways you and your organization can get involved!

1. Read and share Dr. John Ward’s blog, “Think NoHep this World Hepatitis Day.”

2. Check out CDC.gov’s World Hepatitis Day Feature.

3. Connect with the One & Only Campaign and the World Hepatitis Alliance on Facebook and Twitter using the official hashtags #NOhep and #WorldHepDay.

4. Join the #NOHep Thunderclap to amplify the message on social media.

5. Pledge your support for the World Hepatitis Day campaign by sharing your organizations logo on the World Hepatitis Day webpage.


Announcing a new injection safety continuing education program



The Healthcare Learning Activitity Grant Program provides a quality continuing education presentation at low or no cost. HONOReform will provide a grant to organizations sponsoring


continuing education activities for healthcare professionals or consumer-focused activities.

Attendees will receive a flash drive containing the PowerPoint presentation, resources for injection safety, and the award-winning book: A Never Event: Exposing the Largest OUtbreak of Hepatitis C in American Healthcare History.

Description of Offered Programs
Healthcare providers in all types of settings have reviewed and followed safe injection best practices. Nonetheless, the “unthinkable” still happens, with significant impact on the patient and providers. The CDC estimates that there have been more than 50 outbreaks of Hepatitis C and/or Hepatitis B in the past decade due to reused needles, syringes or medication vials. Evelyn and Tom McKnight, founders of HONOReform, will share their own compelling story of infection attributed to reuse of syringes in a medical setting. Additionally, the McKnights will examine factors contributing to the outbreak and make recommendations for prevention.

1. “A Never Event – Don’t let it Happen in your Facility!”
A survivor describes a Nebraska “Never Event” in which 99 patients contracted Hepatitis C when a nurse reused syringes during chemotherapy administration. Root causes of the outbreak are examined as well as resources for prevention.

2. “Preventing Healthcare Transmission of Disease through injection Safety”
This presentation examines causes of patient-to-patient, patient-to-provider and provider-to-patient transmission of disease and offers resources for prevention.

3. “Injection Safety in Dental Practice”
Since 2012 thousands of patients have been put at significant risk of acquiring infectious disease from dental practices in four states. In one instance, the Colorado Department of Health notified 8000 patients that they were at risk for contracting Hepatitis B, Hepatitis C and HIV because their dentist’s practice reused needles and syringes. The McKnights will examine factors contributing to the outbreak and make recommendations for prevention in dental offices.

4. “Becoming an Empowered Patient”
Patients are learning that to receive the best quality healthcare, they need to effectively partner with their healthcare provider. A physician and a survivor of medical error discuss their own personal experiences of patient empowerment and ways to improve the physician-patient partnership.

For more information and to apply, go to Learning Activitiy Program


It is my honor to highly recommend Dr. Evelyn V. McKnight as a speaker. I can think of no one better to present this information. Without a doubt, she exemplifies the motivation and goal-directed approach, in concert with the knowledge and passion to deliver this complex issue. Wanda O. Wilson, PHD MSN, CRNA, Executive Director, American Association of Nurse Anesthetists

Evelyn tells her story with compassion and purpose with the intention to educate listeners about the egregious unsafe practices that continue unabated in healthcare practice sites. I enthusiastically recommend Evelyn McKnight to any group seeking to educate and inspire its members! Janice M. O’Dowd, Certified Continuing Medical Education Professional, Kent Hospital, Warwick, Rhode Island

The McKnights put together an extensive slide show presentation, with multiple resources for further education. They provided tools for healthcare providers to use in their jobs to help educate other providers and present healthcare associated infections. … If you are looking for an engaging educational presentation for your next healthcare conference, I would recommend Tom and Evelyn McKnight. They were very well received, and did a wonderful job. Michele Maryanski, RN CIC, APIC New England Program Director

Our feedback following this course was absolutely outstanding! We hope that Evelyn will continue to educate the public and bring more awareness on safe injection practices so an event like this never happens again. Melissa Adams, Continuing Education Director, AZ Perio Dental Hygiene Study Club



Mentoring the next generation of physicians in patient safety

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE
Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Dr Tom McKnight was recently awarded the University of Nebraska Medical Center’s Koefoot Award for outstanding teaching and mentoring of medical students during the family medicine rural preceptorship. Following are some excerpts from Dr McKnight’s acceptance speech.

Thank you, Koefoot family and the department of family medicine. I am humbled and honored by this award. I know that there are many deserving family physicians in our state that mentor students in outstanding, compassionate care on a daily basis. I read a quote by Gretchen about her father. She said, “Medicine was his life and his love. He devoted all of his time and energy to his practice in Broken Bow.” I hope my own sons will likewise admire the way I have conducted my practice.

I chose to go into family medicine because it provides the opportunity to be involved in peoples’ lives from birth to death. I’ve enjoyed the family medicine experience because of the broad range of challenges emotionally and intellectually whenever I step into an exam room. In my daily routine I often celebrate with new parents when they bring their baby to the doctor for the first time and then go to the next exam room to break the news to a married couple that the husband has terminal lung cancer and has only a few months to live. I have to say family medicine is as challenging and exciting now as it was 35 years ago when I started my practice. Sharing these challenges and rewards with students has made my day to day work life so much richer.

When I was first asked to mentor students early in my career, I quickly agreed. I remembered fondly the time I had spent in Lynch, NE with Dr Becker on my family practice rotation, and I was anxious to provide that stimulating experience for others. At the time that I first accepted students, I was hardly older than the students. I was 28 when I started my private practice. I think back on that now, and am glad I was too naive to realize the big responsibility that I was undertaking. My parents were both teachers, and I think because they made teaching look easy, I thought it would be easy for me, too. I quickly came to a deep appreciation for how challenging teaching is, and gained a deep appreciation for how my parents had shaped so many lives in profoundly productive ways.

Being involved with medical students throughout my career has been extremely rewarding. It is a source of continued stimulation and motivation for keeping up with the advancements of medicine. Sharing the joy with a student of their first delivery or the satisfaction of suturing their first laceration gives me a warm feeling. Its interesting to show them private practice medicine and what it is like to be involved in a community. I love following their educational and career advancement and then have them as specialty consultants. Many of the more than one hundred students I have mentored over my career have become my lifelong friends.

One big challenge to family physicians of my generation was the implementation of electronic medical records. Medical students have played a key role in my education about digital records and have made the transition seamless. Not only have they helped me learn how to keep digital records, they taught me how to access valid information on the web and how to fulfill ongoing family practice continuing education on the internet. And – they also showed me the best apps for Nebraska football stats!

My family has shared the experience of precepting students with me. Evelyn has been a gracious host to the many students who have joined our supper table and who have lived with us throughout their rotation. When our sons were young, I could see how they started thinking about medicine as a career through watching students, which is a different way of seeing medicine than in watching Dad. I was privileged to mentor all three sons during their medical education. It was marvelous to see their compassion and care of patients during their family medicine rotations. It gave them an understanding of what my career is. I’m honored that they have chosen medicine for their own career paths and that they, in turn, mentor students. It’s rewarding and sometimes humorous to talk to them about their own patients. I got a phone call from Curtis the psychiatrist recently, asking me how to treat constipation!

My staff takes great interest in the education of the students. This has become even more important in the era of digital medical records because the first few days of a rotation is spent with staff as the student learns our office based system. Staff gets attached to the students and is sad to see them go when they leave, but are delighted to see their progress as compassionate physicians. Staff often spends more time with patients than I do, which teaches the students the value of teamwork in patient care.

The patient doctor relationship is special. I am privileged to care for 4 generations of families. I am so humbled that they have placed their trust in me, many for 3 decades.

Our patients are always very interested in students. They want them to learn well; they want them to do well. They want them to become exceptional Nebraska family physicians. I see how disappointed the patients are when they come to the office expecting to see their favorite student, only to learn that she has moved on. Patients still ask me about students, years after they have graduated. This is especially true when the student was involved in a family crisis or a family joy such as a birth or a triumph over a serious disease.

You wouldn’t think that something as serious as teaching young people how to be good doctors would provide opportunities for laughter, but the truth is, something funny happens nearly every day. Here are some examples:

We’ve had students (more than one) put a cast on the wrong arm. Or put a blue cast on a little bitty girl dressed in pink who is sobbing. The student thinks she is crying because her arm hurts, but in actuality, she is crying because she wanted a pink cast!

Fremont Health Center is not a big place, but we had a student who could not remember where to park, even after being shown numerous times. In the last week of the rotation, the security guards were threatening to tow.

One time, after a student had completed his first pap smear, the staff member moved the provider’s stool out of the way. The student wasn’t aware that the stool had been moved, and plopped down on the floor!

I asked a student to put a UNA boot on a patient’s foot. When I came into the exam room, there was a blue shoe bootie on the injured foot!

I’m generally a patient man, but sometimes the time it takes some new students to do their first suture repair in interminable. I try to encourage the student to speed things up a bit without worrying the patient by making the comment “The fibroblasts are restless.” Not always does the student crack the code, and I often get a puzzled look from both the student and the patient.

I appreciate the cultural diversity that students bring to our practice. Last fall I had the pleasure of introducing a Chinese student to Nebraska football. Seeing the pageantry of the Red Sea in Memorial Stadium through someone else’s eyes made the experience so much richer for me.

I’ve enjoyed opportunities to serve in ways other than office medicine. I’ve shared with students about our service trips to third world countries, membership on nonprofit boards, medical staff offices and our own patient safety foundation HONOReform. I hope that all of my students will find service opportunities in their careers that have been as fulfilling to them as mine have been to me.

Our own experience with medical error and the work of HONOReform has made me a better doctor because I understand both the doctor and the patient side of the relationship. I’ve learned how to accept responsibility and do the right thing, even when that is a very difficult thing to do. I try to pass these lessons on to the students. From the first day of a rotation, the student hears our story, and throughout our time together, I try to model transparency and ethical behavior in every patient encounter. I want them to become less defensive, more compassionate, and more grateful for this wonderful career as the years go by.

For all of these many gratifying experiences, I thank the students who have spent precious months of their four years of medical school with me. I thank the department of Family Practice for their confidence in me. I thank the Koefoot family for recognizing and supporting rural family physicians in Nebraska. Our work is not done, and I am eager to continue to mentor the next generation of family physicians.

Drug Diversion Reporting…what more can be done

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.
Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

My sincere thanks to the Denver Post’s David Osher and Christopher Olinger for their in-depth piece on drug diversion, reporting and treatment on 4/24/2016.


In this piece, spurred on by the maelstrom of events which surrounded the arrest of a surgical tech from Swedish Medical Center the previous month, Osher and Olinger point out the simple truth that hospitals do not all prescribe to the same standard of safety and precaution when a drug diversion occurs. It was made clear that simply not reporting a theft, leaves open the possibility of hiring of these drug diverting healthcare workers at other facilities and allow them to continue their diverting ways. These reporters did an extensive job in reviewing state health department, licensing board and police records. And the results were unbelievable.
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Take the pledge for Patient Safety Week!

The RN to BSN students of College of St Mary's take the pledge for injection Safety
The RN to BSN students of College of St Mary take the pledge for injection Safety

I was honored recently to speak to the RN to BSN nursing class of the College of St Mary in Omaha, NE. It was heartwarming to interact with such eager and engaged nursing students – their passion for quality nursing care is contagious! The discussion was lively and revealed the students’ quest to understand how they can assure that their care of patients will always be safe.

It was particularly timely to visit the class because this week is National Patient Safety Week and the launch of the healthcare provider pledge for injection safety. Healthcare providers throughout the country will be pledging:



We urge you to take the pledge as well. If you are a healthcare provider, have some fun with taking a selfie with your signed pledge and posting it to your social media channels. Get a group shot with your colleagues. If you are a patient, ask your healthcare provider to sign and take a picture of yourself with her holding the pledge. Here are several pictures of some of my favorite healthcare providers with their signed pledges:



Will you sign this pledge?

“I will use a new needle. I will use a new syringe for you. This is the one and only time they will be used.”