The New York Times- November 17, 2007
Sarah Kershaw

Reused needles and syringes have long been known to put patients and health care workers at risk of contracting hepatitis or H.I.V. through infected blood in the needles and syringes.

But after several outbreaks around the country in doctors' offices and clinics of hepatitis B and C, public health officials and advocates have raised a red flag about the multidose vials commonly used by medical providers. While such vials may reduce waste of medicine, they are more susceptible to contamination than single-dose vials.

Dr. Harvey Finkelstein, an anesthesiologist in Nassau County, told health officials during an investigation that while he used a new syringe for each patient, he would reuse that syringe to draw medicines for that patient from more than one vial. Blood backing up through the used syringe could enter a multidose vial, potentially infecting another patient when that vial was used again.

Last Saturday, state health officials began notifying 628 patients treated by Dr. Finkelstein from 2000 to 2005 that they should get tested. The health officials had known of the doctor's improper practices for three years and had confirmed two cases of hepatitis C linked to his pain management practice.

Earlier this year, in an update of its guidelines on infection control, the federal Centers for Disease Control and Prevention reinforced its recommendation that providers use sterile disposable needles and syringes. It also stated that single-dose vials of medicine "are preferred" because they are much easier to keep sterile.

In an outbreak in 2002, at least 52 people treated at a pain clinic in Norman, Okla., were infected with hepatitis C after a nurse used the same needle and syringe to give drugs to many patients. In New York City earlier this year, health officials linked three cases of hepatitis C to an anesthesiologist who administered intravenous pain medication. The officials said they would notify 4,500 patients who received treatment from the doctor from December 2003 to May 2007, urging them to get tested.

They would not name the doctor and said that while the infections had come from the administration of the pain medication, they were still investigating the exact cause.

Dr. Michael Bell, associate director of infection control for the Centers for Disease Control and Prevention, said any virus is most easily spread through the reuse of needles and syringes. But even if clean needles and syringes are used, the potent hepatitis C virus - or any other infection - could be spread if the vial itself is contaminated through handling or other avenues of exposure and then used again to medicate other patients, Dr. Bell said.

New York State health officials said yesterday they had spoken to the Centers for Disease Control several times over the past few years about making the use of medicine vials safer. They said they wanted to hold discussions also with the Food and Drug Administration.

Officials with the Food and Drug Administration said they were not aware of a federal recommendation on using single-dose vials. "There is no issue using multidose vials, if they are designed to be multidose vials, so long as sterile procedures are used to enter the vial and obtain the medication," the agency said in a statement yesterday.

071117
NYT071109