DPH silent on hows and whys of Salem Hospital HIV and hepatitis exposure

SALEM, Mass — The Massachusetts Department of Public Health said it did an on-site investigation at Salem Hospital earlier this year, after the facility reported a sterility breach that may have exposed up to 450 patients to Hepatitis A, Hepatitis C and HIV.

The lapse happened in the hospital’s endoscopy unit -- and involved the administration of possibly contaminated IVs over a period of two years. Salem Hospital said it uncovered the faulty IV procedure earlier this year -- and that it affected patients seen over the course of about two years.

That IV protocol was fixed soon after. The hospital said it has contacted all patients who might have been affected by the error and, as DPH advised, offered free screening and follow-up care.

Thus far, DPH said none of the patients contacted have come down with Hepatitis or HIV.

“I think it’s more common than we realize,” said Nasia Safdur, MD, PhD, a professor of infectious diseases at the University of Wisconsin. “It’s typically in settings where there’s high turnover or there’s a time rush or something interrupts your normal scheme of best practices.”

These days, all areas of hospitals tend to be busy -- but perhaps especially endoscopy units, some of which are still working through a backlog of patients who put off screening during the pandemic.

Safdur said that with bloodborne pathogens, such as Hepatitis and HIV, one common route of transmission is through the reuse of disposable syringes and needles.

“You might forget, on a busy day, for instance, that you’ve used a syringe on a patient and it’s in your pocket,” she said. “And then when a second patient needs that same medication you might attach a different needle but it’s the same syringe.”

Safdur said even though the syringe never came in direct contact with the patient, it would still be considered just as contaminated as the needle -- because in the course of injection, blood is often drawn up.

Another possible route of transmission is the reuse of single-use medication vials.

Safdur said that ultimately, it is the responsibility of the health care team to ensure that proper sterile technique and infection control procedures are followed -- especially given patients are sometimes unaware of what’s happening in the hospital.

“It’s not really their responsibility,” she said. “They have to be able to trust the system.”

But, Safdur said it’s not unreasonable for patients who can speak up -- to do so, if they see something that doesn’t look right.

“So, for instance, the patient could ask questions about what medication they’re getting, is this a single-use vial, when was it drawn up,” Safdur said. “And then they can also observe at the time the IV is being put in, whether the healthcare worker has cleaned the site with an antiseptic before introducing the needle. I think these are very reasonable questions for patients to ask.”

And on that last point -- the use of an alcohol swab before an injection -- it’s a small but crucial step to prevent infection, as puncturing the skin potentially introduces some of the bacteria naturally present on the skin.

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