Midlands Voices: How to prevent outbreaks

Langan, of Fremont, Neb., is the executive director of the Hepatitis Outbreak National Organization for Reform and the HONOReform Foundation. Booth is chief executive officer of the Fremont Area Medical Center.

Many Midlanders, especially those who live in and around Fremont, are aware that a tragic outbreak of hepatitis C in Nebraska was revealed in September 2002. Ninety-nine Nebraskans, many of whom were very sick with cancer and treatment for cancer, contracted the illness through reuse of syringes and improper use of saline bags.

The outbreak was traced to the private office of Dr. Tahir Ali Javed, a medical oncologist who was on the staff of the Fremont Area Medical Center (FAMC). He left the country around the time of the initial investigation into the cause of the outbreak. At last report, he lives and works in Pakistan.

Despite the passage of time, this tragic outbreak, with its deep effect on those 99 patients and their families and friends, has not been forgotten. There were staggering costs to the families who were involved, including three premature deaths. The Nebraska Excess Liability Fund paid more than $16 million to the victims.

Evelyn McKnight, a Fremont audiologist and mother of three who was being treated for breast cancer at the time, used her entire settlement to help start the Hepatitis Outbreak National Organization for Reform (HONOReform).

Consider some sobering national findings. Between 1998 and 2008, reuse of medical equipment by American health care workers -- particularly syringes but even needles and other items strictly designated for one-time use -- caused 33 documented outbreaks of blood-borne pathogens. The vast majority of these outbreaks occurred in outpatient clinics.

Migration of care from inpatient to outpatient settings allows for less strict oversight and regulation. Since 2008, many additional outbreaks have been recorded by the Centers for Disease Control and Prevention. Widespread outbreaks in Las Vegas in 2008 and Colorado in 2009 are especially troubling.

More than 60,000 people in Las Vegas were notified that they may have contracted hepatitis C during the course of a routine preventive procedure. The cause? During colonoscopies, health care workers at three outpatient clinics reused vials of Propofol marked for one-time use only, and they reused syringes. As many as 115 Nevadans were infected with hepatitis C.

The cost of this investigation alone is estimated at $16 million to $21 million. At the first of many civil trials there, the Clark County jury recently found two drug companies liable and registered a verdict of $500 million in punitive damages against them.

The UNLV School of Public Health recently surveyed people throughout Las Vegas. Sadly, more than half said they are less likely to have a colonoscopy.

It was discovered last July that a surgical technician in Colorado who is a drug addict injected herself with prefilled syringes of Fentanyl that were prescribed for patients in the recovery room. She then refilled those syringes with saline and placed them back on the anesthesia cart. Thirty-three Coloradans, many of whom were very ill to begin with, were infected with hepatitis C.

Working with industry leaders to encourage distribution of injection devices that cannot be reused, HONOReform Foundation and its partners and stakeholders have coordinated a mission to help ensure that every medical injection in America is a safe one.

The leadership of Fremont Area Medical Center is committed to safe and effective infection control in its hospital and, over the past few years, has expanded its efforts to include a much more comprehensive approach. FAMC fully supports HONOReform and its ongoing efforts, through its national education campaign and in its work on Capitol Hill, to make sure injections in all American health care settings are safe.

Along with the CDC Foundation, the HONOReform Foundation started the Safe Injection Practices Coalition, which developed the One and Only Campaign (One Needle, One Syringe, Only One Time). This campaign is being piloted in Nevada and New York.

In its recognized policy work, HONOReform hosted its third annual Advocacy Conference in Washington, D.C., in February. More than 40 advocates from 15 states gathered on Capitol Hill to ask lawmakers to dedicate $30 million in programmatic funding to allow the CDC to continue to concentrate on preventing outbreaks in outpatient clinics and throughout the Veterans Administration system.

We unite to help solve a sad and horrible public health problem that deeply affects individuals and communities.

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