Anjeanette Damon Reno Gazette Journal March 7, 2008 Amid reports of unsafe practices at three area surgical centers, Washoe County health officials are reviewing existing cases of hepatitis and HIV infections to determine whether any might be linked to the centers.
No suspicious patterns were detected in the department’s original investigation of those cases and nothing immediately indicates that any disease has been transmitted in Northern Nevada because of unsanitary practices, officials said.
Officials on Friday named the three Northern Nevada surgical centers that investigators say were using unsafe procedures that might have put patients at risk: Digestive Health Center on Kietzke Lane, Saint Mary’s Outpatient Surgery Center at Galena on Wedge Parkway and Sierra Center for Foot Surgery in Carson City.
At all three centers, officials said the problems have been corrected.
“The bottom line is we have not uncovered any reason for immediate concern for the people treated at those facilities,” said Randall Todd, director of epidemiology for the Washoe County District Health Department.
The investigation is ongoing, and state officials have yet to inspect each of the area’s 19 ambulatory surgical centers. So far, they’ve inspected 10 this week. Investigators said they found no problems at two centers and minor, procedural problems at the other five centers.
Under pressure from local health officials, the Reno Gazette-Journal and the Las Vegas Review-Journal, the state health division began on Friday to release the preliminary results of statewide inspections launched this week in the wake of a hepatitis C outbreak in Las Vegas.
The results:
o Two area centers, Digestive Health Services and Saint Mary’s Outpatient Surgery Center at Galena, failed to properly disinfect equipment in between patient procedures, according to Mike Willden, director of the Nevada Department of Health and Human Services.
o A third clinic, Sierra Center for Foot Surgery in Carson City told investigators that an anesthesiologist had been reusing plastic syringes on multiple patients several years ago, Willden said.
“Saint Mary’s takes very seriously the findings of the state surveyors and took immediate action to comply with their recommendations while they were on site at our facility,” spokesman Gary Aldax said in a prepared statement.
Dr. Thomas Cazes, the medical director for Digestive Health Services, said the two pieces of equipment in question were being properly sterilized “in the same high-quality manner in which the endoscopes themselves are disinfected.”
He said the problem seen by the health division was not the sterilization procedure, but the fact that the bite blocks and polyp traps are considered single-use items. Bite blocks are plastic products used to protect a patient’s mouth when a medical scope is inserted down the throat during procedures. And, polyp traps are instruments used during colonoscopies to remove polyps from the colon. Cazes said those pieces of equipment will now be used once and then thrown away. Cazes said the items are labeled for single use, but can be used multiple times if proper sterilization is employed. He said the re-use of the items was a “convenience rather than cost issue” because the center wanted to have plenty of the items on hand. He said the practice wasn’t unsafe and no patients were ever in danger of infection.
The investigation is still on-going into the Sierra Center for Foot Surgery’s practices. The center’s proprietor, Dr. Jeff Bean, said the problem occurred with a contracted anesthesiologist, who was confronted by the center’s nurse and asked to stop. “Like most surgery centers, Sierra Center for Foot Surgery uses physicians for anesthesia during surgery,” Bean said in a prepared statement. “Years ago, an anesthesiologist reportedly used the same syringe with a different needle. “The center does not reuse syringes. The center reported the anesthesiologist incident to health officials. No disease transmission occurred.”
Pressure prompts clinic identification
The state health division is in the middle of inspecting each of the state’s 50 ambulatory surgical centers after a hepatitis C outbreak in Las Vegas was linked to unsafe practices at the Endoscopy Center of Southern Nevada.
The health division had delayed releasing the names of centers where unsafe procedures had been observed, frustrating local health officials who wanted to begin investigating whether any disease spread could be linked to those centers.
The delays came because of a department policy that gives the centers a 10-day period to respond to the violations. The Department of Health and Human Services decided to release the names Friday after consulting the governor’s office and the attorney general’s office, and after the Reno Gazette-Journal began preparing a lawsuit to compel the state to release the names.
“If we have a problem in our community, we want to conduct an investigation as timely as possible so we can get to the bottom of it and negate it,” Todd said.
“Would it be helpful for us to know as soon as such a problem is discovered? Absolutely, it would be very useful. That is a system problem that the state will need to fix fairly quickly.”
Todd said his investigators have already launched an investigation into whether any of the county’s existing cases of acute hepatitis C, acute hepatitis B and HIV can be linked to any of the clinics with reported violations.
“They are literally as we speak starting that process,” Todd said Friday. “According to their preliminary look, most of those (cases) had explainable risk factors.”
Since 2004 in Washoe County, there have been 11 cases of acute hepatitis C, 33 cases of acute hepatitis B and 134 cases of HIV infection.
Health officials expressed dismay at the violations being discovered by inspectors, saying some of the practices defy the most basic sanitary procedures. “I would not make the assumption that everything is fine in terms of infection control,” Todd said. Some patients visiting area surgical centers on Friday said they were concerned about possible unsafe procedures after news from Las Vegas that 40,000 people were put at risk by an endoscopy center there.
“That’s one thing I asked about, and they said they had no problems, they don’t reuse anything,” said Al Tallman, 61, of Fallon, who visited the Digestive Health Center Friday for a colonoscopy.
Reporters Frank X. Mullen Jr. and Kristin Larsen contributed to this report.
