Several breaches of safe injection practices identified during an outbreak of septic arthritis in New Jersey

Multiple violations of injection safety and infection prevention practices – from lack of hand washing to inappropriate reuse of medication vials – have been identified following an epidemic of septic arthritis in an ambulatory care facility of New Jersey in 2017, according to a survey published today in Infection control and hospital epidemiology, the journal of the Society for Healthcare Epidemiology of America. Investigators found that 41 patients with osteoarthritis had contracted rare and painful infection after injections into the knee joints, 33 of which required the surgical removal of damaged tissue.

This important and costly epidemic highlights the serious consequences that can occur when health care providers do not follow infection prevention recommendations. "

Kathleen Ross, Epidemiologist, New Jersey Department of Health

For 31 patients badigned to Medicare alone, the processing fee claimed exceeded $ 5 million.

As a result of initial reports of three cases emanating from a local hospital addressed to state and local health departments and several complaints filed directly with the facility in March institution has voluntarily ceased to perform procedures. An Infection Control State Assessment Team identified 41 cases and numerous breaches of infection control best practices, including poor hand hygiene, unsafe injection practices and poor cleaning and disinfection.

After collecting medical records and self-reported data, the team of public health and health professionals from the state and county health departments, as well as from the New Jersey Consumer Division , have made an unexpected visit to the institution. The on-site visit included interviews with staff, medical records reviews, an badessment of the handling of regulated medical waste and an observation of the fictitious procedures performed by staff during the closure of the facility.

The evaluation team found numerous violations of appropriate infection prevention and injection safety practices, including the absence of hand-washing stations or alcohol-based smears in examination rooms. , exposed syringes, syringes containing injectables prepared up to four days in advance, reuse of single-use and multi-dose vials. In addition, the examination tables where the injections have taken place have been cleaned "at most" once a day, while a cleaning of the surface before each preparation is recommended unless a clean barrier is used .

"Nationally recommended infection prevention and control practices are applicable to all environments where health care is provided, however, ambulatory care facilities may not provide the necessary infrastructure and resources to support infection prevention activities, and often lack regulatory oversight, "Ross said.

Prior to the reopening of the facility, state officials made recommendations in the 2016 Guide for Infection Control in Ambulatory Care: Minimum Expectations for Safe Care. An Infection Control Consultant was advised to review practices and help with changes. No other cases were reported after the implementation of the prevention recommendations.

Further research is needed to identify the best way to provide infection prevention training and education to ambulatory health care providers, Ross said. Training in infection prevention should be promoted at all levels of professional training for all health staff when hired and on an ongoing basis, with supervision to ensure skills.

"Epidemics related to unsafe injecting practices indicate that some health personnel are unaware of, do not understand or adhere to the basic principles of infection prevention and asepsis techniques, thus confirming the need in education and in-depth implementation of infection prevention recommendations, "Ross said.