Biotech Values

[DewDiligence]

Manhattan Dialysis Clinic May Have Infected Patients With Hepatitis C

[No wonder at-home peritoneal dialysis is catching on in a big way. The word “may” in the title of this article is patently superfluous.]

http://www.nytimes.com/2009/03/06/health/06clinic.html

›March 6, 2009
By RONI CARYN RABIN

At least nine kidney patients who now have hepatitis C may have been infected during treatment sessions at a Manhattan dialysis center that closed last year, according to the results of an investigation published on Thursday by the federal Centers for Disease Control and Prevention.

Four of the patients’ infections are genetically linked, the investigators said, indicating that those patients were almost certainly infected at the clinic, the Life Care Dialysis Center at 221 West 61st Street. The center was closed last year following allegations of unsanitary operating conditions.

According to the report, which appeared in the C.D.C.’s Morbidity and Mortality Weekly Report, still other patients may also have been infected at the clinic. But the investigation was confined to the 162 who were being treated as of September 2008, when the center closed.

Earlier statements from state health officials had confirmed only one infection with the virus among clinic patients. Hepatitis C is an often silent infection that can lead to cirrhosis, liver failure and cancer.

The patients whose infections were genetically linked came in for treatment on the same days of the week, and two had been hooked up to the same dialysis machines, the investigators reported.

The clinic tested patients occasionally for hepatitis C and was aware that some had tested positive for infection with the virus, but it never informed those patients or state health officials as required, the report said.

The investigation was triggered by a patient who called state health authorities in January 2008 to complain that the clinic was dirty, said Dr. Jenifer Jaeger, a C.D.C. officer assigned to New York State and the new report’s principal investigator.

The Office of Health Systems Management, part of the New York State Health Department, began an investigation in March, Dr. Jaeger said. It found, among other things, that the patient who made the phone call had tested positive for hepatitis C in January. “She had not been informed,” Dr. Jaeger said.

Dr. Walter Wasser, the physician who was the operator and medical director of the dialysis center, could not be reached for comment. He was fined $300,000 in September 2008 and surrendered the clinic’s operating certificate, but the state Office of Professional Medical Conduct has not taken formal action against him.

The dialysis center was described by the investigators as a filthy place where employees did not wash their hands properly, disinfect equipment or always wear gloves when treating patients. Dried blood was found on treatment chairs, bleach solution was not stored or prepared properly, and there was no separate clean area for storage or preparation of medications.

The dialysis center, located at a convenient spot near public transportation, operated at full capacity, and turnover time between patients was short, investigators said.

In one case described in the report, a single bleach-soaked gauze pad was used to clean an entire patient dialysis station, including the machine’s surfaces and equipment like the blood-pressure cuff and shared computer monitor and keyboard. Many staff members were unaware of the center’s written infection control policies about cleaning and disinfection.

Medical guidelines require strict testing and monitoring of dialysis patients for hepatitis C infection, both at the start of treatment and every six months afterward. The clinic tested patients erratically, sometimes once a month and sometimes every other year, according to the report.‹