Unsafe injection practices such as those of Dr. Harvey Finkelstein have exposed at least 60,000 patients to hepatitis B and hepatitis C in the past decade, according to the federal Centers for Disease Control and Prevention.
Calling it "a wider and growing problem," the CDC documented 33 outbreaks in the United States that resulted in 448 people getting hepatitis B or C from doctors' offices or clinics from 1998 to 2008.
In all the outbreaks, the infections were caused by "failure of health care personnel to adhere to fundamental principles of infection control," the authors said in the review published last Tuesday in the Annals of Internal Medicine.
The cases ranged from Finkelstein, a Plainview pain management doctor who in 2004 was observed reusing syringes in multidose vials, causing at least one transmission of hepatitis C, to a Nevada endoscopy clinic where poor anesthesia practices last year put 40,000 at risk for the virus.
Evelyn McKnight said she was surprised the CDC's numbers were so low. McKnight, a Fremont, Neb., audiologist, was one of 99 patients who got hepatitis C in 2004. She contracted the virus at a Nebraska oncology clinic where she was being treated for breast cancer.
"I would have thought the number was closer to 100,000," said McKnight, who has since started HONOReform, a foundation that has worked closely with the CDC to promote good infection control.
The CDC report reflects the tip of the iceberg, the authors acknowledged. That's in part because health care has shifted from hospitals, where standard infection control practices -- such as not reusing needles or syringes -- are regulated, to doctors' offices and clinics, where they may not be, chief author Nicola Thompson said.
"Outpatient settings often do not have the same type of focus on prevention and infection control," she said. "There's been a lack of oversight."
Hepatitis C is the most common chronic blood-borne viral infection in the United States, according to the CDC; about 3.2 million Americans have a lifelong, chronic infection. About 1.4 million Americans have a chronic hepatitis B infection. Both can lead to liver disease and death.
Seven of the 33 outbreaks -- including the Finkelstein case -- occurred in New York. Claudia Hutton, a spokeswoman for the state Department of Health, said that reflects New York's better oversight, not sloppier health care workers.
"We have more data, better surveillance and better investigations," Hutton said.
Thompson agreed, praising New York's surveillance and investigations compared with many other states.
But the department came under fire for its handling of the Finkelstein case. It took almost three years before the state began informing patients of his practices. Since then, the state has initiated changes to prompt and speed up investigations. It also has passed a law requiring ambulatory surgery centers -- including practices like Finkelstein's -- to be accredited like hospitals. To see more of Newsday, or to subscribe to the newspaper, go to http://www.newsday.com Copyright (c) 2009, Newsday, Melville, N.Y. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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