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Most iatrogenic HCV cases unidentified until symptom onset

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May 30, 2018

Between 2001 and 2011, more than 130,000 patients may have been exposed to hepatitis C virus infection because of medical errors, and only 37% were proactively notified before the onset of symptoms, according researchers.

“A major problem is that two out of three times, we're not learning about unsafe medical practices until it's too late,” Charles Defendorf, DO, an internal medicine resident trained at Rowan University School of Osteopathic Medicine, said in a press release. “Once a patient is diagnosed with an infection, we can go back, alert, and screen anyone else connected to that facility. But by that time there has usually been opportunity for thousands more to have been infected.”

In a review published in the Journal of the American Osteopathic Association, Defendorf and colleagues said 35 reports of injection safety violations were made over the 10-year period that required patient notification related to blood-borne pathogen risk. The reports came from 17 states and Washington, D.C.

The researchers found that roughly 63% of iatrogenic HCV infections were identified only after patients displayed symptoms and were diagnosed. The infected individuals were then notified, and other patients at risk were screened. Only 37% of infections were discovered due to timely reporting of injection safety violations, and notifications were often found to be ineffective, they said. In one instance, 4,490 patients were notified of possible , but only 841 of these patients were screened for HCV. This oversight left thousands of unscreened and possibly infected patients, who, in turn, could be transmitting the infection to others, according to the release.

Defendorf emphasized the importance of patient awareness of HCV symptoms. Although serious liver damage generally does not occur until years after acquiring the virus, patients often experience a brief bout of symptoms approximately 4 to 6 weeks after infection. The ability to recognize these symptoms can lead to early treatment and avoidance of major liver damage.

“Abdominal pain, nausea, vomiting and jaundice are the primary symptoms,” Defendorf said in the release. “If these are experienced within 4 weeks after a procedure, it’s a good idea to get tested.”
Patients are also urged to advocate for themselves by understanding the protocols for safe injections. The CDC’s “One and Only” campaign addresses these protocols in detail. They include the following:

  • Never use the same syringe to administer medications to more than one patient, even if the needle is changed.
  • Do not enter a vial with a used syringe or needle.
  • Do not treat more than one patient with medications packaged as single-use vials.
  • Even with medications packaged as multiuse vials, medication should be allotted to only one patient whenever possible.
  • Bags or bottles of IV solution should not be used as a shared source of medication for multiple patients.
  • Preparation and administration of injected medications should be done with absolute adherence to infection control guidelines.

“Hepatitis C transmission in medical settings is highly preventable, and there are clear guidelines and standards to keep patients safe," Defendorf said in the release. "All health care workers should know and abide by them.” – by Jennifer Byrne

Disclosures: The authors report no relevant financial disclosures.