EXETER, N.H. — New Hampshire health officials are still exploring all possibilities for the cause of a hepatitis C outbreak at Exeter Hospital.
That word came Monday from Dr. Jose Montero, the state’s public health director, who said an investigation into the outbreak remains inconclusive, more than three weeks after the Division of Public Health Services began probing the event.
Among the scenarios being explored by DPHS is the possibility that an employee infected with hepatitis C transmitted the virus to patients by abusing narcotics and then injecting patients with a used syringe.
That scenario has played out in three medical facilities in the country in the last decade, according to information collected by the Centers for Disease Control and Prevention.
The number of people linked with the outbreak at Exeter Hospital stood at 14 Monday. The only known connection between the patients is the hospital’s cardiac catheterization laboratory (CCL) and recovery area.
In an interview Monday, Montero said state health officials are focusing their investigation on three main areas.
One is the hospital’s procedures for preventing infections, managing narcotics and disposing of medications.
The second aspect of the investigation deals with how well employees comply with the hospital guidelines in those areas, Montero said.
As a third possibility, state health officials are also exploring the potential that hospital narcotics were abused by an employee who then spread the liver disease to patients by using a contaminated syringe.
“The three things are still on the table, and we’re still actively looking into those three things,” Montero said Monday.
Asked if the state has any evidence suggesting drug diversion by an Exeter Hospital employee was a factor in the outbreak, Montero replied: “I’m not saying ‘Yes’ or ‘No.’ I’m telling you I don’t feel that it is appropriate for me to disclose any of the findings until I know more about them.”
The hospital has contacted all 879 patients who were treated at the lab since April 2011 to ask them to get tested for the liver disease. A patient treated at the CCL in September remains the earliest known victim.
Exeter Hospital also declined Monday to directly address whether evidence of drug diversion by an employee has been uncovered.
“Experts at the state continue to lead the investigation and we are deferring to them about the potential possibilities,” Exeter Hospital senior marketing and public relations analyst Ryan Lawrence wrote in an email Monday. “At this point we are not ruling out any potential causes.”
According to a study conducted by the CDC, there were 22 incidents during the last decade in which hospitals notified patients they had potentially been exposed to hepatitis B or hepatitis C as a result of unsafe syringe practices.
In 19 of the cases, it was a patient infected with hepatitis C that was identified as the source of the virus.
One of the most common causes of patient-to-patient transmission was using syringes or insulin pens on multiple patients. Another common error was using the same syringe to draw medicine from a container multiple times.
In the remaining three cases, the virus was spread by infected physicians who passed on the disease to patients. In each case, the physician injected narcotics stolen from the hospital, then reused contaminated syringes, according to the study. In all three cases, physicians injected the anesthesia drug fentanyl.
In those three events, a combined 40 people contracted hepatitis C, and more than 13,000 patients were notified of the potential for infection, according to the CDC study.
Rather than trying to educate health care workers about the dangers of drug diversion, the study suggests that developing new safety features, such as syringes that change color to indicate prior use, could be a more effective means of addressing the problem.
In one recent instance, a former Mayo Clinic radiology technician in Jacksonville, Fla., was found to have infected two patients with hepatitis C, one of whom later died of complications linked to the virus, according to information provided by the office of the U.S. Attorney in Florida’s Middle District.
The technician, Steven Beumel, admitted in court that between 2006 and 2008, he stole syringes of fentanyl during procedures and replaced them with contaminated syringes filled with saline.
Epidemiologists from the CDC, the Mayo Clinic, and the Florida Department of Health worked for more than three years before they identified Beumel as the cause of the infections, according to information provided by the U.S. Attorney.
Beumel, 48, pleaded guilty in May to one count of tampering with a consumer product resulting in death, four counts of tampering with a consumer product resulting in serious bodily injury, and five counts of stealing fentanyl by deception, according to the U.S. Attorney’s office. He faces a maximum penalty of life in federal prison.
As of Monday, 700 of the 879 patients who were treated at the cardiac catheterization laboratory in the last 13 months had either been screened for hepatitis C or scheduled an appointment for the test, according to information provided by the hospital.
Montero said state health officials are planning to make a public announcement about a new batch of lab results on Wednesday, June 13.
The 14 patients who tested positive for hepatitis C have all been notified of the results, but hundreds more are still awaiting word on the test results.
Patients who test negative for hepatitis C will be notified by their primary care physicians, who will receive the results in the mail.
Among the hundreds of patients awaiting test results is a 34-year-old Portsmouth woman named Jen, who agreed to share her experience with Foster’s Daily Democrat on condition that her last name be withheld.
Jen was treated at Exeter Hospital’s cardiac catheterization lab four times in 2011, last receiving treatment on Aug. 31. She was among the first group of patients contacted by the hospital to undergo testing.
In an interview Monday, Jen said she has been frustrated by a lack of communication and support from the hospital and the state. She questioned why state health officials chose to relay test results via the postal service, potentially adding days to the turnaround time.
“There’s no one that’s at all involved in this that’s not going to be deeply impacted by it in some way,” she said. “Negative or positive, it’s not something that you just walk away from.”
Lawrence said Exeter Hospital is doing its best to expedite the screening process and make the process as convenient as possible for patients.

(c)2012 the Foster’s Daily Democrat (Dover, N.H.)
Distributed by MCT Information Services