An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario.

BACKGROUND: Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). OBJECTIVE: To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. METHODS: Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case's procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. OUTCOME: A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. CONCLUSION: Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.

Retooling for managed care: one size does not fit all!

As long as the patient admission of MA to PPS is no higher than 30 percent, the impact is easily managed within normal operations, requiring only minor realignment. When the percentage jumps to 40 percent, the impact begins to affect normal operations, requiring significant changes in operations Once the ratio exceeds 50 percent, the organization can be threatened if major changes are not made to accommodate the disruption in the operational systems and financial impact.

Planning for positive clinical & financial returns with telemonitoring.

Telemonitoring is a burgeoning market in the home care industry. Making the decision to invest in telemonitoring technology can be difficult in the best situations. The financial investment is significant, the risks can be high, and the need to achieve a positive return is critical to future success. In spite of the risks, this relatively new technology in home care holds the promise for the redefinition of the industry.

Wound competencies & OASIS. One organization's plan.

Testing assessment competencies in clinical staff can be a challenge, but testing wound assessment competency is even more difficult. Add to that the Outcome ASsessment Information Set (OASIS) wound questions and it's no wonder that nurses are confused. The VNA, Western Pennsylvania decided to take a unique approach to wound assessment competencies by combining multiple methods of instruction and self-learning followed by a "hands-on" approach to testing.

Supplies in demand. Managing medical supplies under PPS.

It is no longer news that the consolidated billing requirement under the home care prospective payment system (PPS) mandates that home care providers are responsible for providing specified supplies to patients under a current episode of care. With more than one year of experience and data measuring the cost of providing supplies, providers are now looking at ways to better manage distribution, control utilization, and minimize costs. Although each organization must make decisions based on its own needs, several steps in this process have proven to be consistently effective.