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Wednesday, 19 October 2011

Sterilization incident - just the tip of the iceberg

This week, nearly 6800 people who received service from a physician’s office in Ottawa are receiving letters advising them that the sterilization practices were inadequate and the potential exists for the transmission of the bloodborne infections of Hepatitis B and C and HIV. This is merely the most recent in a series of situations where inadequate sterilization has been identified.   It will not be the last.  If anyone has information on the effectiveness of such public notifications, please post as a comment, or email to drphealth@gmail.com. 
The first wave on incidents were amongst hospitals, or more exactly specific services within hospitals with poorer infection control practices.  This high profile situation is different as it is a community based health care worker where problems have been identified.  CTV item on Ottawa clinic
While tattoo parlours and other personal service establishments are often subjected to health inspections, no such progam has existed for community based health care workers.  Physicians, dentists, nurse practitioners and others are regulated by their own professional bodies and not public health inspectors.  In office inspections are almost unheard of and are usually only instigated following multiple public complaints.   It is another dirty secret that deserves to be cleaned up. Office standards for sterilization exist but are not routinely enforced.  Infection prevent has pedominately been a limited to hospitals and occassionally residential care settings.  Incidents like this are just the start of unmasking the extent of poor office based health care practices. 
The chances are supposedly less than one in a million that any disease will be transmitted. Reading the comments to the CTV story is worthy for all public health professionals, while not reflective of all the general population, it does reflect extreme views.  There are at least two commenters claiming that their current infections are secondary to the physician’s office, and a handful of individuals who are stricken by the anxiety of having been told, but not yet reassured by negative testing. There are several comments taking shots at the Medical Officer of Health for the handling of the process, despite being the agency of last resort to ensure transparency and clear that perhaps other agencies should be responsible and failed to act. 
Fortunately, transmission of these viruses outside of sexual transmission or sharing of injection works is not common.  Hepatitis B immunization has become the norm.  Hepatitis C is rarely transmitted sexually and improved blood system screening and reduced injection use may help stem the tide.  There are newer approaches to HIV disease control that show promise to increase control – and that includes encouraging everyone to be tested routinely. There will however be many more incidents, lots of anxiety and concern, and the occassional preventable illness before a more universal approach to protection is achieved.   
(Blood donors have these diseases screened for at each donation, and while not the place to have the first testing – one should ask why we are all not donating at least 2-3 times per year)

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