CRNAs Surrender Licenses in Nevada Hep C Investigation
By Debra Wood, RN, contributor
Five nurse anesthetists voluntarily surrendered their licenses to the Nevada Board of Nursing as public health authorities continue investigating needle and syringe reuse, which appears to have spread hepatitis C to six patients who underwent procedures at a Nevada clinic.
“I cannot believe it, and I feel so sorry for the patients who have been exposed,” said Wanda Wilson, CRNA, Ph.D., president of the 37,000-member American Association of Nurse Anesthetists (AANA).
AANA called on all health-care workers to exercise the utmost care in vigilance when performing or observing injections. It’s not enough to look the other way or change jobs. Wilson encourages any nurse witnessing an unsafe practice to report it, as she has in the past.
“It is astounding that in this day and age there are nurse anesthetists, anesthesiologists, and other health-care professionals who still risk using needles and syringes on more than one patient, or know of such activities and don’t report them,” Wilson added. “Published standards and guidelines dictate that single use and disposal of these products is the best way to ensure patient safety.”
Although saving money is usually the reason providers cite for reusing syringes, Wilson said it’s a false economy, because needles and syringes are cheap. If transmission of hepatitis or HIV occurs, it can ruin a nurse anesthetist’s career.
In January 2008, the Southern Nevada Health District received notice from area physicians about three acute cases of hepatitis C. It now has found six cases. Five of the patients had surgery on the same day at the Endoscopy Center of Southern Nevada in Las Vegas. Genetic testing on four of the cases from that day indicated the infections originated from a common source.
The health district and the Nevada State Bureau of Licensure and Certification began investigating, with consultation from the Centers for Disease Control and Prevention. The team found that administration of anesthesia might have exposed patients to other patients’ blood when a syringe was reused to draw up additional medication, potentially contaminating the vial. Then rather than discarding the single-use vial, medication was drawn from it for another patient.
The patient who had a procedure on a different day does not have genetically identical hepatitis C as the others, indicating the problem that allowed disease transmission was not a one-time event.
An answering machine picked up calls at the surgery center, but the mailbox was full and not accepting new messages.
The health district urges all patients who had procedures at the center requiring injected anesthesia between March 2004 and January 11, 2008, contact their physicians to be tested for hepatitis C, hepatitis B and HIV. The department is recommending screening for all three, since they can be transmitted the same way.
Screening is necessary, because it can take several months or longer for hepatitis C symptoms to appear, and 80 percent of patients will exhibit no signs or symptoms, the health district said.
The health district is sending out letters to 40,000 patients who may have been exposed.
University Medical Center Quick Care Centers are offering a free visit to anyone receiving a letter. The visit will include a physician’s order for testing.
Nevada Department of Health and Human Services is inspecting all 50 licensed ambulatory care facilities. As of March 8, 2008, it had found two Reno facilities not using proper sterilization procedures: Digestive Health Center and St. Mary’s Outpatient Surgery at Galena. Staff at the Sierra Center for Foot Surgery in Carson City admitted reusing syringes. Similarly in Clark County, the Gastrointestinal Diagnostic Center was found to have deficiencies related to syringes.
“It is important to note there has been absolutely no known infectious disease reports associated with any of the facilities that were notified of deficient practices,” said Mike Willden, director of Nevada HHS.
The Nevada State Health Division encourages all people considering a surgical procedure to ask their health-care provider about office protocols and standards prior to consenting. In addition to not reusing needles and syringes, the facility should sterilize equipment after each patient use. The division suggests patients also inquire if the facility has ever received a complaint about the spread of an infectious disease related to its practices. Patients can obtain a copy of a facility’s most recent federal survey or complaint survey by writing the Bureau of Licensure and Certification (BLCweb@health.nv.gov).
“Patients need to be a partner in this and question the provider,” Wilson addd.
It’s good advice. Nevada is not the only state where this has occurred. The New York State Department of Health is investigating a Long Island anesthesiologist and pain management specialist for reusing syringes to draw up medication from multidose vials, a practice that spread the hepatitis virus to his patients.
“If the hepatitis C outbreaks in New York and Nevada demonstrated anything, it was that such incidents occur regardless of a provider's degree, credential or title,” Wilson said. “For any group to suggest otherwise is to put its collective head in the sand. It is irresponsible, negligent, and a sure invitation for yet another Nevada or New York situation to occur.”
The association pledges to help identify the root cause of the Nevada cases and assist authorities with solving the problem. Wilson said that might include mandating infection control continuing education.
“The most important action we at the AANA feel we can take from this point forward is to do absolutely everything in our power to study and correct the infection-control issue related to drug handling and administration, and make whatever changes are necessary to ensure the safety of future anesthesia patients,” Wilson said.
When a 2002 Oklahoma hepatitis outbreak, with 100 cases of B and C, was traced to a nurse anesthetist in a hospital outpatient clinic, AANA mailed a copy of its infection control guide to all members along with a letter reinforcing the importance of strict compliance to ensure patient safety. The association also conducted a survey of practices and attitudes about needle and syringe reuse.
The association called the results “eye opening” and “alarming,” with 3 percent of responding anesthesiologists indicating they reused needles and/or syringes on multiple patients and 1 percent or less of CRNAs, other physicians, nurses and oral surgeons reporting reuse. Extrapolating from the survey’s findings, the association estimates, in 2002, approximately 1,000 anesthesia professionals might have been exposing more than a million patients to risks of contaminated needles and syringes.
“We need to remember, as nurses, we are about patient safety and advocating for patients and not take short cuts,” Wilson concluded. “This is a sad event, and we will address it head on.”
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