Hepatitis C Infections Found in Clinic Patients

March 6, 2009
Hepatitis C Infections Found in Clinic Patients
By RONI CARYN RABIN

At least nine kidney patients were infected with hepatitis C while being treated at a Manhattan dialysis center that was closed by state health officials last year, according to the results of an investigation published Thursday by the federal Centers for Disease Control and Prevention.

The viruses found in four of the infected patients were close genetic matches to viruses in other clinic patients, the investigators said, indicating that the four were almost certainly infected by contaminated equipment at the clinic, the Life Care Dialysis Center at 221 West 61st Street. The center was ordered closed after investigators found unsanitary operating conditions.

According to the C.D.C. report, which appeared in the centers’ 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 July 2008.

Earlier statements from state health officials had confirmed one viral infection among clinic patients. Hepatitis C often has no easily observable symptoms but can lead to cirrhosis, liver failure and cancer.

The patients whose infections were genetically traced to others 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 knew that the nine became infected after they started coming to the clinic, but it never informed them, the report said. It notified state health officials in three cases, the report said.

The investigation was started in response to a patient’s call to state health authorities in January 2008 complaining that the clinic was dirty, said Dr. Jenifer Jaeger, a C.D.C. officer assigned to the state and the chief investigator responsible for the report.

State health officials began an investigation in March, Dr. Jaeger said. It found, among other things, that the caller had tested positive for hepatitis C in January 2008. “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 Thursday. 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 investigators described the center 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 center 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 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.

http://www.nytimes.com/2009/03/06/health/06clinic.html?_r=1&ref=health