the patient perspective on public health protections for cancer patients and hai prevention

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The patient perspective on public health protections for cancer patients and HAI prevention. Evelyn McKnight, AuD www.HONOReform.org www.OneandOnlyCampaign.org www.ANeverEvent.com. Our story…. 2002. 2. What the investigation found. Improper port flush procedure - PowerPoint PPT Presentation

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The patient perspective on public health protections for cancer patients

and HAI preventionEvelyn McKnight, AuD

www.HONOReform.orgwww.OneandOnlyCampaign.org

www.ANeverEvent.com

2

20022

Our story…

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What the investigation found

• Improper port flush procedure

• Index case came to clinic in 2000

• Complaints from housekeeping, pharmacy, lab, nursing and patients but

hospital claimed “no jurisdiction”• Unsafe practices for at least 16 months

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What happened to the victims?

1 liver transplantMailliard, et al. Outcomes of a patient to patient outbreak of Genotype 3a Hepatitis C. Hepatology 2009; 50: 361-368

1 sexual transmission

6 deaths

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What happened to the victims? 89 lawsuits

Community in conflict

28 SVR’sMailliard, et al. Outcomes of a patient to patient outbreak of Genotype 3a Hepatitis C. Hepatology 2009; 50: 361-368

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What Happened to the Perpetrators?

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www.ANeverEvent.com

Striving to prevent healthcare transmission of bloodborne pathogens

Hepatitis Outbreaks National Organization for Reform

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Safe Injection Practices Coalition• Raises awareness about

safe injection practices

• Aims to eradicate outbreaks resulting from unsafe injection practices

AAAHC, AANA, APIC, BD, CDC, CDCF, Covidien, Hospira, HONOReform, NACCHO, NE Med Soc, NV Med Assn, Premier, MEDRAD, FDA; State Partners: NV, NJ,NY, NC

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• Programmatic funding• Congressional Briefing• GAO investigation• FDA, CMS, HHS & CDC collaboration• External Stakeholder Engagement (NQF, IHI)

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Ten years later - 2012

12 and being counted!

Thank you for standing up

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