Exeter Hospital employee led to an outbreak of hepatitis C

Editorial Team / Admin · Jun 16, 2012

Narcotic abuse would go to 0.

Impossible. There are people so desperate for their fix that they will dig that syringe or vial out of the sharps bin for that fraction of a drop of what just might be their narcotic of choice. I've seen it happen. The cameras aren't going to be able to do anything unless there is an obscene number of them in each room to catch every possible angle no matter where anyone is standing/furniture placed/whatever. The risks here far outweigh the benefits when you consider the one in one million chance of catching someone diverting drugs vs something ending up on Facebook or YouTube that shouldn't. It's amazing what people don't already have the good sense not to post. This would just add to it.

PrimaFacie · Jun 16, 2012

Single dose administration will in the long run be the effective standard of practice.
This may be a case of cross contamination of a multi-dose vial. This may not have been a nurse at all. This may be an incidence of a huge systems error that need to be rectified.

I fail to see how a single dose vial would eliminate the problem if the nurse used the needle on him/herself, refilled the syringe with saline, and then used it on the patient.

And even if it was inside the multidose vial from this same practice (using the needle on him/herself and then sticking same needle into multidose vial) it is still a problem of shared needles starting the problem, and single dose will reduce the number of people infected but wont stop the problem.

ICK...the thought of this really upsets me.

Esme12, ASN, BSN, RN · Jun 16, 2012

It upset me to.....I think we need to see how this started before debating the solution. The thought of this is frightening for everyone. I inherently feel from a long nursing career that there is more to this story for it to have gone on for two years.

I smell something afoot..... :idea:

Esme12, ASN, BSN, RN · Jun 16, 2012

1. wow, congrats on 34 years!
2. I am just trying to think of a solution - Some people (not you, but just saying) will complain, but me, my mind jumps to how do we provide a fix? This fix not only eliminates the potential of the contamination but addresses the huge problem of substance abuse by nurses in the system.
3. Nurses are always worried about their responsibilities being decreased, and at the same time, they are often complaining that we are so busy and overwhelmed. It does not remove the professionalism of nursing or lower the standards, to create specialties within our profession. ie: Diabetes educators, wound care specialists, etc.
4. If the pain management team is staffed appropriately, the wait for a narcotic shouldn't be any longer than the current system.
5. I disagree with your statement of: "....the actual incidence of abuse is rather small." I recently reviewed the public records of disciplinary actions on nurses in a few states where I am licensed, and they are mostly for substance abuse.....and there are gazillions of them.
6. It is ok to not agree, but I hope you are open minded should the situation ever present its-self as a reality.

Thank You! It's been a great run, I've had an amazing career.

Disciplinary actions of nurses for abuse can be alcohol as well. Diversion is a problem but when compared to the overall numbers of nurses is rather small. In 2006 the amount of nurses disciplines was 7,899 out of the 4,363,206 nurses registered (APN,PN,LPN,VN) which adds up to only 0.18%. This includes ALL reasons for discipline including offenses other than diversion/impairment.

So it actually, while the incidence has increased, so has the population of licensed nurses leaving it still an only 0.18% of all licenses granted are disciplined.

https://www.ncsbn.org/09_AnalysisofNursysData_Vol39_WEB.pdf

I think "a fix" needs to be explore when the causative facts are revealed and then a revised standard of care can be developed from this unfortunate and frightening turn of event. I have spent an entire career being open minder to change....so I think I'll adapt when the time comes.

I think a greater attention to the virulence of HEP C is going to be the lesson here.

PrimaFacie · Jun 16, 2012

Some interesting facts from that study:

--Chemically dependent nurses usually work for several years before undergoing disciplinary action.

--Drug related violations represent 25% of all violations

--One-fifth (21%) of disciplined nurses recidivate;

But there are only disciplinary actions if they refuse to enter, or fail out of a program.The CA nurse diversion tx program has had "Over 1,200 registered nurses have successfully completed the program"

That is just CA. And all those nurses who went to programs, didn't find its way into the study because those nurses were not disciplined. (unless they went un-clean later and got caught)

So disciplinary actions research is not an accurate way to count all the nurses who divert, or have a narcotics issue.

But it was interesting research, all the same.

Esme12, ASN, BSN, RN · Jun 16, 2012

Good points.......

This thread is not about disciplining licenses it's about the HEP C scare in NH. It is not, however, a debate about nursing license discipline or limiting nursing practice. Personally I think being more selective about admittance into school and granting licensure might be a solution....one just never knows.

Again THIS incident may have NOTHING what so ever to do with diversion so time will tell if this conversation even needs to take place.

morte, LPN, LVN · Jun 16, 2012

Also, remember use does not =diversion, nor does diversion=use

Scarlette Wings · Jun 27, 2012

Woweeee. I would hate to be the Infection Prevention team at that hospital...

You and me both. It was nerve wracking at the recent APIC meeting they started to educate on all the steps and the legal methods of handling just such occurrences.

Esme12, ASN, BSN, RN · Jul 19, 2012

UPDATE

A former employee of Exeter Hospital in New Hampshire was arrested today on federal charges related to a Hepatitis-C outbreak that has infected at least 30 people, the U.S. Attorney’s office said.
David Matthew Kwiatkowski, 32, was charged with tampering with a consumer product and obtaining controlled substances by fraud, prosecutors said. Kwiatkowski, who worked in the hospital’s cardiac catheterization lab from April, 2011, to May, 2012, faces up to 24 years behind bars.
“We have eliminated the menace this ‘serial infector’ posed to public health and safety,” New Hampshire District U.S. Attorney John P. Kacavas said in a statement.

The hospital released a statement......

Exeter Hospital today released the following statement after news broke that one of its employees was arrested for allegedly causing a hepatitis C outbreak:
At 2:00 pm today the US Attorney’s Office announced they have arrested David Matthew Kwiatkowski for his involvement in the hepatitis C outbreak at Exeter Hospital.

David Kwiatkowski began working at Exeter Hospital in April of 2011 as a temporary employee, otherwise known as a “traveler.” As with all travelers at Exeter Hospital, pre-employment drug testing and standard and criminal background checks were performed. He was hired into a regular full-time position as a Cardiovascular Tech in our Cardiac Catheterization Lab in October of 2011, where he worked until he was placed on leave at the onset of the investigation in May, and then was later terminated.
We understand there is a great deal of public interest in this situation; however, as this remains an ongoing criminal investigation, we are unable to comment on any of the details related to the case. In addition to being a former employee, David Kwiatkowski has also been a patient of Exeter Hospital which further limits our ability to comment more specifically.

The indictment is a critical milestone in this incredibly difficult and painful situation. It is the result of extraordinarily thorough and complex investigations on the part of Exeter Hospital and numerous state and federal agencies. Exeter Hospital has done everything it can to support these ongoing investigations including providing some of the specific information about Kwiatkowski’s suspicious actions noted in the US Attorney’s press release. We want to thank the dedicated experts from each of these agencies who helped with this tragic matter.

“It is deeply disturbing that the alleged callous acts of one individual can have such an impact on so many innocent lives. As a result of his alleged actions, people in our community, who in many cases are the friends and neighbors of the 2,300 people who work here, now face the challenge of a potentially chronic disease,” said Kevin Callahan, president and CEO of Exeter Hospital. Exeter Hospital also recognizes the disruption this has created for over 1,100 individuals who have had their lives unnecessarily interrupted by the required testing.

Callahan noted; “Even in the middle of this crisis, our 2,300 employees and affiliated medical staff have continued to selflessly care for thousands of people who have continued to seek treatment at the hospital over the last several months.”

The events of the past several months have demonstrated that no healthcare organization can rest in its pursuit of the highest possible quality and safety for its patients. Even the best systems and nationally accepted protocols can be corrupted by actions driven by illegal intent.

Wow.....frightening. This guy is a traveler.....they are checking other states.