Hepatitis C Infections Found in Manhattan Dialysis Clinic Patients

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

Hepatitis C Infections Found in Clinic Patients

By RONI CARYN RABIN

Published: March 5, 2009

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.