VCU physician calls for better infection-control standards for outpatient facilities

By Anne Buckley

Clinics and other outpatient facilities should employ the same strict infection-control standards as hospitals to prevent patient-to-patient transmission of Hepatitis C outbreaks like one described in today’s issue of the Annals of Internal Medicine, according to a Virginia Commonwealth University infectious disease expert.

“Health care organizations must develop up-to-date infection-control practices, not just in hospitals but in all hospital-associated and freestanding outpatient facilities,” Richard P. Wenzel, M.D., chair of Internal Medicine at the VCU School of Medicine, wrote in an editorial in the same issue.

The article upon which Wenzel based his editorial documents a large outbreak of Hepatitis C among cancer patients receiving chemotherapy treatment at a freestanding clinic in Nebraska. The article traced the outbreak to a nurse who would draw blood from patients’ central venous catheters, send that blood to the laboratory and then use the same syringe to aspirate fluid from a bag of saline and flush the venous catheters of subsequent patients. The infection rate for the 367 patients studied during a 16-month period was 27 percent, according to the article. The nurse later was fired.

Wenzel wrote that the rate of patient-to-patient transmission of Hepatitis C at U.S. health care facilities continues to increase despite published infection-control guidelines. He said one reason is a push to reduce the costs associated with expensive, injectable anti-cancer drugs that are dosed on a per-kilogram basis.

“Prefilled, single-use syringes for flushing catheters must become the system-wide standard in hospitals and clinics to minimize transmission of blood-borne pathogens,” Wenzel wrote. The single-use syringes would increase costs, but “our obligation to provide safe care leaves no room for compromise.”

Wenzel also calls for physically separating patients with central venous catheters in order to monitor the risk of transmitting a virus from one to the other.

“All patients with vascular access lines should be considered vulnerable and should be shielded from an exposure to a roommate infected with a blood-borne pathogen,” he wrote.

“Hospitals in the United States, the Joint Commission on Accreditation of Healthcare Organizations, and the Centers for Disease Control and Prevention have placed a low priority on encouraging effective outpatient infection-control activities,” Wenzel wrote. “It is very difficult to define rates of adverse events without a system to measure infectious outcomes in patients after health care visits that place them at risk for care-related infection.

“In the future, widespread introduction of computerized medical records may be an important step toward generating better data on infectious outcomes,” he said.