AANA Condemns Unsafe Injection Practices

Main Category: Nursing / Midwifery
Also Included In: Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 07 Mar 2008 - 0:00 PDT

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In a decisive response to recent incidents in Nevada and New York in which patients were infected with hepatitis C allegedly through the reuse of needles and syringes, the American Association of Nurse Anesthetists (AANA) called on healthcare professionals across the nation to exercise the utmost care and vigilance when performing or observing injections on patients.

"It is astounding that in this day and age there are nurse anesthetists, anesthesiologists, and other healthcare professionals who still risk using needles and syringes on more than one patient, or know of such activities and don't report them," said Wanda Wilson, CRNA, PhD, president of the 37,000 member AANA. "Published standards and guidelines dictate that single-use and disposal of these products is the best way to ensure patient safety. Patient safety is our primary focus --- not cost savings, time savings, or any other factor."

Wilson added that while the AANA believes the vast majority of Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, and other healthcare professionals who give injections practice in a safe manner according to established drug-handling and administration guidelines, recent hepatitis C outbreaks at an endoscopy center in Las Vegas, Nev., and a pain management facility in Long Island, N.Y., leave no doubt that unsafe practices are still occurring and can cause great harm to patients.

"My heart goes out to the patients in Las Vegas and Long Island who contracted hepatitis, and I fervently hope that testing doesn't reveal additional patients who might have been infected at these facilities," Wilson said.

"These types of incidents are completely unacceptable, and the AANA is determined to help uncover the root cause and correct the problem," Wilson said. "We invite other national healthcare organizations, as well as governmental entities and drug manufacturers, to work with us to restore public trust and achieve this goal of ensuring and enhancing patient safety when it comes to the use of needles, syringes, and single-use medication vials. Only by working together will we be able to develop and implement universally accepted techniques and guidelines, and share in the responsibility of their use and enforcement without hesitation."

On February 29, health officials in Nevada closed the Endoscopy Center of Southern Nevada in Las Vegas after six patients were diagnosed with hepatitis C. The outbreak was traced back to nurse anesthetists reusing syringes to draw up medicine from single-use vials for multiple patients. According to the investigation report of the Southern Nevada Health District, "common practices" were identified that "would allow disease to be transmitted in this manner." Officials are notifying more than 40,000 patients that they should be tested for hepatitis and HIV. (View the investigation report at http://health.nv.gov)

In November 2007, reports surfaced in the media that anesthesiologist Harvey Finkelstein, MD, a Long Island pain management specialist, was under investigation by the New York State Department of Health for reusing syringes to draw up medicine from multi-dose vials and exposing thousands of patients to blood borne pathogen infection. On December 14, 2007, the Department of Health contacted approximately 8,500 patients who had been treated by Finkelstein prior to January 15, 2005, urging them to be tested for hepatitis and HIV if they had received an injection from the doctor. (View the investigation report at http://www.health.state.ny.us) Finkelstein's record in the nine years prior to the reuse investigation included 10 malpractice settlements.

"Anesthesia practiced according to professional guidelines is safe," Wilson said. "We intend to use these incidents to reinforce the importance of adhering to established guidelines and to gain a better understanding of common practices related to the use of needles, syringes, and single-use medication vials by nurse anesthetists and other healthcare professionals.

"What is clearly not the answer to the problem is for any group of providers --- physician or other -- to insist that 'it couldn't happen to us,' because that's certainly not in our patients' best interests," said Wilson. "Every clinician and professional society lives in a glass house when it comes to a critical issue such as infection prevention. If the hepatitis C outbreaks in New York and Nevada demonstrated anything, it was that such incidents occur regardless of a provider's degree, credential, or title. For any group to suggest otherwise is to put its collective head in the sand -- it is irresponsible, negligent, and a sure invitation for yet another Nevada or New York situation to occur."

The AANA refused to put its head in the sand when, in 2002, a hepatitis outbreak in Norman, Okla., was traced back to a nurse anesthetist supervised by an anesthesiologist at a hospital outpatient clinic. More than 100 patients who were treated at the hospital were diagnosed with hepatitis B or C (although it was impossible to determine precisely how many patients were infected prior to treatment or during treatment at the facility).

In response to the situation in Norman, the AANA took immediate action. CRNAs across the country were mailed a copy of the AANA Infection Control Guide along with a letter reinforcing the importance of strict compliance to ensure patient safety. Press releases were disseminated to educate, inform, and reassure the public about safe injection practices. The AANA also hired a research firm to conduct a random telephone survey of CRNAs, anesthesiologists, and other clinicians to learn more about practices and attitudes on needle and syringe reuse.

The results of the survey were eye-opening, and confirmed the AANA's suspicions that the problem is more widespread than believed.

Among the different categories of health professionals surveyed, 3 percent of anesthesiologists who responded indicated they reuse needles and/or syringes on multiple patients. CRNAs, other physicians, nurses and oral surgeons reported reuse at 1 percent or less. Extrapolating from the survey's findings, 3 percent of anesthesiologists plus 1 percent of CRNAs equated in 2002 to approximately 1,000 anesthesia professionals who might have been exposing more than a million patients to risks of contaminated needles and syringes.

The AANA distributed this information widely among public and professional communities, including to the Centers for Disease Control. Despite these alarming results, the AANA was unable to generate interest in a summit meeting of healthcare organizations to address the issue. "Perhaps if the issue had been given more attention at the time, we wouldn't be revisiting it again today," Wilson said.

"The most important action we at the AANA feel we can take from this point forward," Wilson added, "is to do absolutely everything in our power to study and correct the infection control issue related to drug handling and administration, and make whatever changes are necessary to ensure the safety of future anesthesia patients."

About the American Association of Nurse Anesthetists (AANA)

Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 90 percent of the nation's CRNAs. As advanced practice nurses, CRNAs administer approximately 27 million anesthetics in the United States each year. CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals. Additional information about the AANA is available on the Internet at http://www.aana.com.

American Association of Nurse Anesthetists
http://www.aana.com

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