New Jersey is fighting injection risks, particularly lapses by healthcare providers who reuse syringes and expose patients to hepatitis and other blood borne diseases.
The New Jersey Department of Health is part of a national campaign to educate medical workers on injection safety, and so far has reached 4,000 clinicians across the state — doctors, nurses, and allied health professionals. The slogan of the “One and Only” campaign is straightforward: “One needle, one syringe, only one time.”
That such a campaign is even necessary seems surprising: How could any healthcare worker use injection practices that can spread disease? But according to Dr. Barbara Montana, medical director for communicable disease at the state Department of Health, lapses in best practices are all too common.
In one of the state’s most egregious cases, at least 29 patents got hepatitis while undergoing chemotherapy in 2009 at an oncology practice in Toms River.
Addressing a seminar last week on efforts to prevent healthcare-acquired infections, Montana focused on outbreaks that have occurred in outpatient settings — doctor’s offices, oncology practices, ambulatory surgery centers.
“The reason for the focus on outpatient is because our care is transitioning more and more to outpatient environments,” Montana said. Acute care hospitals have entire departments working on infection control. In an outpatient practice, this may be just one of many tasks performed by one very busy worker.
“The sick patients used to be cared for in acute care settings where there is a lot of oversight,” Montana said. “More and more procedures are being performed on sicker and sicker patients in nontraditional settings.”
Montana listed best practices for handling syringes, all “no brainers” that include: Never administer medication through the same syringe to multiple patients; don’t reuse a syringe to enter a medication vial; do not administer medication from a single dose vial or intravenous bag to more than one patient; and prepare medications in clean areas that are not potentially contaminated with blood or other body fluids.
These common sense rules are violated repeatedly, Montana said. The damage extends beyond the patients who’ve gotten sick through improper injection techniques, because these disease outbreaks make people fearful of getting preventive screenings like colonoscopies. “If you perceive that your risk of disease transmission is greater than your risk of colon cancer, you are going to opt out of that screening procedure. That is the opposite message of what we want to do in public health,” Montana said.
The One & Only Campaign is led by the Centers for Disease Control and Prevention and the Safe Injection Practices Coalition. New Jersey is a member of that coalition, as is Evelyn V. McKnight, a national spokeswoman for safe injection practices who addressed the conference last Friday at the New Jersey Hospital Association in Plainsboro. McKnight contracted hepatitis while being treated for breast cancer in 2002 at an oncology practice in Nebraska.
“It just made everything so much harder. I had to recover from cancer, and then to add on another life threatening disease just complicated the issue,” McKnight said. She survived both cancer and hepatitis, then founded HONOReform, a national advocacy organization for safe medical injection practice.
The conference was co-sponsored by Healthcare Quality Strategies Inc., whose medical director Dr. Andrew Miller said bringing the message of safe practices to the front line healthcare workers is crucial. Referring to McKnight’s battles with cancer and hepatitis, he said, “If the people mixing the meds and giving the infusions were properly instructed and educated, the problem might not have happened.”
McKnight wants to see passage of a federal “safe injection practices act.” Last fall, Rep. Frank Pallone Jr. (D-6th District) asked the Government Accountability Office to investigate the recent outbreaks of blood-borne diseases caused by unsafe injection practices.
In his letter to the GAO, Pallone said nationwide in the last decade more than 130,000 patients have been notified of potential exposure to hepatitis or HIV due to lapses in basic infection control practices. “The majority of these cases derived from the reuse of a syringe intended for a single use, and the re-entry into a vial intended for a single dose administration,” Pallone said. A study by the GAO could become the impetus for federal legislation, but it has yet to be resolved how such a measure would be enforced.
David Knowlton, president of the New Jersey Healthcare Quality Institute, said a law governing syringe use by healthcare professionals sounds like a good idea. “I only wish it were that easy,” he said.
There is no practical way to monitor how the healthcare system handles syringes, Knowlton said. “I don’t think legislation is the solution — it has to be quality assurance within the health institution. We have to put a culture of safety in place that prevents this from happening.”
Consumers can push the system forward through vigilance, he said. “You should be able to see a syringe being opened up in front of you. And you should ask questions. You can say, ‘I’ve been reading a lot about infections, and I’m worried. Do you have precautions here, am I safe here?’” Knowlton said the syringe issue is similar to the movement in healthcare to promote better hand hygiene by clinicians. “There is no question that the biggest front line in preventing infections is hand hygiene, but it’s very hard to enforce.”
Elizabeth Woody is director of public policy and government relations for Franklin Lakes based BD Corp., one of the leading makers of syringes, and a founding member of the Safe Injection Practice Coalition. New Jersey, New York and North Carolina are piloting the One and Only campaign, which she said has been able to spread the safe injection message nationwide. BD provided initial support to the campaign when it launched about four years ago, before the funding was provided by the CDC, she said.
“When we first heard about these outbreaks of hepatitis a couple of years ago, we couldn’t believe that this was going in the U.S.,” Woody said. “We have certainly been aware of these kinds of practices in developing countries and have been working on safe injection practices efforts outside the U.S. for some time. But the fact that this is occurring here in this country was shocking to us and that is why we were one of the founding members of the coalition.”
She said the key is education and awareness, noting there is no federal agency charged with oversight of patient safety. The One and Only campaign seeks to “get out and in front of this a little bit and reeducate providers who should know these best practices from their training, but may have forgotten them for whatever reason. And also to educate patients to ensure they are being active recipients of their healthcare and are aware of what is going on.”