CDC Study: Failures to Follow Infection Practices Have Placed More than 60,000 Patients at Risk for Hepatitis B and C

In the last decade, more than 60,000 patients in the United States were asked to get tested for hepatitis B virus (HBV) and hepatitis C virus (HCV) because health care personnel in settings outside hospitals failed to follow basic infection control practices, according to a new study by the CDC.

This first full review of all the CDC investigations over the past 10 years of healthcare-associated viral hepatitis outbreaks appears in the January 6th issue of the journal Annals of Internal Medicine.

"This report is a wake-up call," said Dr. John Ward, director of CDC's Division of Viral Hepatitis. "Thousands of patients are needlessly exposed to viral hepatitis and other preventable diseases in the very places where they should feel protected. No patient should go to their doctor for health care only to leave with a life-threatening disease."

In the United States, transmission of HBV and HCV while receiving health care has been considered uncommon. However, a review of CDC outbreak information revealed a total of 33 identified outbreaks outside of hospitals in 15 states, during the past decade: 12 in outpatient clinics, six in hemodialysis centers and 15 in long-term care facilities, resulting in 450 people acquiring HBV or HCV infection.

Patients were exposed to these potentially deadly diseases because health care personnel failed to follow basic infection control procedures and aseptic technique in injection safety. Reuse of syringes and blood-contamination of medications, equipment and devices were identified as common factors in these outbreaks.

"More and more patients in the United States receive their health care in outpatient settings," said Dr. Denise Cardo, director of CDC's Division of Healthcare Quality Promotion. "To protect patients, infection control training, professional oversight, licensing, innovative engineering controls and public awareness are needed in these health care settings."

CDC officials say the report shows the need for ongoing professional education for health care providers, as well as consistent state oversight in detecting and preventing the transmission of bloodborne pathogens in health care settings.

CDC assists local health departments by providing routine surveillance, outbreak investigation support, field personnel and lab expertise. CDC also works with key partners to ensure adherence to proper infection control practices.

CDC and its partners are working to address this important patient safety problem through a number of efforts, including:

-- Improving viral hepatitis surveillance, case investigation and
outbreak response, such as support for health departments to
thoroughly investigate all individuals identified to have HBV or HCV
infection;
-- Strengthening the capacity of state and local viral hepatitis
prevention programs;
-- Augmenting the CDC's National Healthcare Safety Network, the national
surveillance system for tracking health care-associated infections, to
collect outpatient setting information;
-- Partnering with the Hepatitis Outbreaks' National Organization for
Reform (HONOReform), a patient advocacy foundation, to create patient
and provider education materials;
-- Continued improvement of injection safety practices through
educational outreach efforts with professional nursing and
anesthesiology organizations;
-- Working with partners in the dialysis, diabetes and long-term care
communities to promote safe care practices;
-- Working with regulators and professional societies to strengthen
licensure and accreditation processes with emphasis on safe injection
practices;
-- Exploring ways to improve curricula in nursing and medical schools
related to safe health care practices.

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Burst Appendix or Stomach Flu? Hopkins Children’s Experts Say Doctors and Parents Can Sort Out Symptoms with a Checklist

A young child arrives at the emergency room after several days of abdominal pain, vomiting, diarrhea and is sent home with a diagnosis of viral gastritis and treatment for the symptoms. The child seems better for a while, only to return to the ER with worse symptoms and a ruptured appendix, a life-threatening complication of appendicitis.

The scenario is not uncommon, experts say, because children with appendicitis don’t usually have the classic symptoms of the condition, but pediatricians at the Johns Hopkins Children’s Center say there are ways for doctors and parents to tell the difference early on between a potentially deadly burst appendix – which can kill in a matter of days, even hours – and a stomach bug.

Past research has found that half of appendicitis cases are misdiagnosed when they first present at the emergency room or the doctor’s office, and that up to 80 percent of appendicitis cases in children younger than 4 years of age end up in rupture.

Says emergency room pediatrician Jennifer Anders, M.D., of Hopkins Children’s, who has seen her fair share of burst appendices, “appendicitis should always be near the top of the list of potential culprits when a child has ANY abdominal pain, vomiting, and malaise,” keeping in mind that many children don’t have fever or lose appetite the way adults might.

Doctors recommend that children with prolonged or severe abdominal symptoms that do not go away or improve should be evaluated for ruptured appendix. Consider the following questions:

Do blood tests indicate elevated white cell count?
Was there sharp pain in the lower right portion of the abdomen, which later subsided and became dull and spread across the abdominal area? Paradoxically, as appendicitis worsens and the appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.
“It’s counter-intuitive, but if that sharp pain improves or subsides and becomes more generalized, it’s actually a bad sign,” Anders says. “As the severely inflamed appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.”

Does the child have diarrhea? Diarrhea, which can be a marker of bowel inflammation, resulting from the infection caused by the burst appendix, often distracts doctors and puts them on a different track. Diarrhea may not be a classic sign of appendicitis, it may signal a ruptured appendix.

Did the child have vomiting, which later stopped?

The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix before they reach the OR.

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