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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

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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