Government investigators have cited a New Hampshire hospital for violations in infection control that may have contributed to an outbreak of hepatitis C, including leaving powerful anesthesia drugs unattended in its cardiac catheterization lab.
Exeter Hospital also allowed a medical technician, identified as accused “serial infector” David Kwiatkowski, to work with open wounds.
The citations prompted hospital executives to write a policy requiring staff members to report contagious conditions such as hepatitis C, and to pledge to better secure potent anesthetics, which health care workers sometimes steal to feed drug habits. Exeter’s plan of correction was filed Thursday and released by the US Centers for Medicare & Medicaid Services along with a statement of deficiencies issued in July.
Working with federal authorities, state health regulators began investigating the facility in June, after the hospital reported a hepatitis C outbreak among patients treated in the heart center. Last month, law enforcement officials arrested Kwiatkowski, who is accused of stealing syringes filled with the drug fentanyl and replacing them with dirty ones that were used on patients.
Kwiatkowski has been infected with hepatitis since at least 2010, and tests in recent months have identified at least 30 patients thought to have been infected by him. Thousands more treated at the hospital are being screened for hepatitis.
The cardiac lab uses a secure machine to store anesthesia that requires a thumbprint and password to access. However, according to the report, a nurse in charge of preparing the drugs before a procedure told inspectors that the drugs were typically left on top of the machine while the nurse walked to the other side of the surgical table to put on a lead apron.
“Probably not the best practice,” the nurse told investigators, the report said. On a subsequent visit, inspectors observed the same staff member leaving the room to get the apron.
“Once they get the medication it’s not supposed to be out of their eyesight,” John Martin, manager of the New Hampshire Bureau of Licensing and Certification, said in an interview. “Apparently, there were times where there were brief windows of opportunity where there could be diversion” of the drug, he said.
Kwiatkowski was a traveling worker, assigned to Exeter Hospital in April 2011 by a staffing agency and then hired as a full-time employee in October. His arrest has prompted a far-reaching investigation because he had worked at facilities across the country. Officials in at least eight states and at some 17 hospitals have said they are investigating whether Kwiatkowski could have exposed patients to the virus, which can cause serious liver damage over time. His training and certification authorized him to work primarily as an X-ray technician, a position common in cardiac labs.
Federal prosecutors, in an affidavit, said Kwiatkowski would have had no reason to possess a syringe containing fentanyl and had been caught in another state swiping one from an operating room. A supervisor at the Exeter lab told investigators that Kwiatkowski would sometimes enter the lab even when he was not scheduled to be there, bringing in lead aprons and setting them down next to the drug storage machine, according to the court filing.
In the plan filed Thursday, the hospital said it has changed the procedure for handling injectable anesthesia used in the heart lab, requiring the nurse to place syringes in a secure drawer until they are used.
A manager of the lab told inspectors that a technician who worked at the hospital between April 2011 and May 16, 2012 — identified by Martin as Kwiatkowski — came to work with open wounds, including lesions and a finger cut that required stitches. He was repeatedly asked to leave the work area, at least once during a procedure, because the wounds were weeping or he had blood-like stains on his scrubs, the report said.
On several days during a week in September 2011, Kwiatkowski showed up for work after an unspecified procedure with an incision that was bleeding. He finally required surgery to close the incision, which was near a blood vessel, the inspectors found.
The hospital was cited for not properly identifying when infected employees should be barred from working. It submitted a new policy for reporting and monitoring infection risks among the staff.
“Employees with a contagious condition are prohibited from working until cleared” by hospital officials, the policy reads. The document stipulates that it covers contracted staff and lists conditions that must be reported, including hepatitis C. It also prohibits anyone with a wound that has the potential of opening from working directly with patients.
A hospital spokeswoman did not immediately return requests for comment Thursday evening.
The state’s survey extended beyond the catheterization lab and the hospital was cited for several other violations.
Glucose monitors were not routinely cleaned between uses, according to the inspection report. The hospital created a new guideline for sterilizing the machines. Ceiling tiles in the surgical suites were perforated and not washable, and the hospital said it would replace them.
Hospitals routinely flag rooms of patients with certain highly contagious diseases, requiring anyone who enters to wear a gown and gloves. Inspectors observed a physical therapist enter a flagged room without the protective gear. The hospital said it updated its policy around this issue and will more regularly monitor compliance.
Helen Mulligan, spokeswoman for the federal health agency, said the state will conduct an unannounced follow-up survey to see whether the hospital is complying.