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After Infections, Hope for Exeter Hospital

 |  By Marianne@example.com  
   August 08, 2012

Exeter Hospital, a 100-bed facility in New Hampshire, is now infamous nationwide following a bizarre Hepatitis C outbreak—a plot that continues to unravel.

The outbreak, which was detected in May, spawned a series of investigations that led to radiology technician David Kwiatkowski, who allegedly infected at least 30 patients with the virus.

Kwiatkowski allegedly injected himself with Fentanyl meant for patients and returned the dirty syringes to treatment areas, where they were used on patients. The traveling medical technician became infected with the disease in 2010, according to court documents.

He was employed at Exeter from April 1, 2011 to May 25, 2012 and had worked at several other healthcare organizations around the country, all of which are currently testing their patients for the disease as well.

But the bulk of media attention remains on Exeter. Though Kwiatkowski was arrested in July, Exeter faced several surveys and inspections, as well as accusations that it did not take staff allegations against the technician as seriously as it should have.

In its defense, Exeter Hospital administration has faced all of these surveys, accusations, and media inquiries directly, while keeping its patients informed. Its approach to the crisis reminds me of a larger scale version of the situation Forbes Regional Hospital and its parent company, West Penn Allegheny Health System, faced in 2004. Eight years later, Forbes has bounced back, and Exeter can too.

Address the situation head-on

Forbes' public health crisis arose when it purchased new scopes to be used during colonoscopies, which the hospital believed to be the same model as its then-current scopes. Thus, it continued to sterilize the scopes in the same manner as it did the older versions.

Unfortunately, it turned out the new scopes had undergone a significant design change which made the sterilization process in place no longer adequate. (The hospital maintains that the scope company did not inform them of the change.)

By the time it discovered the problem, the hospital had already conducted about 200 procedures using the improperly sterilized scopes. The hospital immediately stopped using the scopes, contacted the CDC, and learned that any risk of blood-borne infections was remote. The risk was so remote, that experts let Forbes know that it was unnecessary to notify patients.

But, "We knew we should do more," said Tony Farah, MD, chief medical officer of West Penn Allegheny Health System and Mark Rubino, MD, chief medical officer of Forbes Regional Hospital in a joint-article to the Pittsburg Post-Gazette earlier this month.

"We not only reviewed our procedures, we also elected to inform our patients. We made free testing immediately available around their schedules. We set up a toll-free number to answer questions and ensured a professional was always available to answer any questions."

Exeter did not have the luxury of choosing whether or not to inform its patients of the outbreak, but the hospital is going out of its way to make sure all patients, whether affected or not, are informed about the situation. It created a microsite dedicated to the Hep C outbreak with news updates, information about the clinical response team, and a Q&A section about the disease. Exeter's media representatives have also been forthcoming with information to news outlets.

This assures patients that the hospital is on top of the situation.

Keep talking about it

So far, Exeter has done a decent job of managing public perception of the organization, considering the breadth of the outbreak. But it's what the hospital does in coming weeks, months, and years that will determine if it will be able to get its image back on track.

At Forbes, hospital leaders found the solution was to keep talking about the situation. Though tests discovered that not a single patient was infected, and the public admission resulted in the parent health system being tied up in litigation over the situation for several years, Farah and Rubino believe continuing to inform the public was the right thing to do.

"Keeping quiet might have enabled us to avoid a prolonged court case and negative publicity, but it was never a consideration," they wrote. "We believed then, as we believe now, that our patients have a right to all information related to their health care. We value both patient safety and transparency."

Transparency is something Exeter must focus on as it continues to face inspections and other probes. Even if under normal circumstances it would not release certain results, it must do so in the next few years.

Anything less than absolute transparency while the organization is under the shadow of this outbreak will look suspicious, if not sinister.

Explain why the incident will not happen again

Part of this transparency effort must include demonstrating to the public that your organization is taking steps to ensure this situation will not happen again.

At Forbes and West Penn Allegheny, that meant not only updating the cleaning procedure for the new scopes, but revising the entire process for how they purchase medical equipment—and letting the public know about it.

Exeter's task is loftier, but not impossible. It must put measures in place to better guard medications, investigate staff allegations against coworkers, and vet its potential employees. The clinical response team section of its Hep C outbreak microsite is a great start, but the organization needs to go further.

Highlight your strengths and move forward

Forbes and West Penn Allegheny were ultimately able to move forward from their public health scare by publicizing its strengths and successes. The health system was recently named one of the country's top performing health-care systems based on patient care quality and efficiency for the third year and U.S. News & World Report also recognized four of its hospitals.

Forbes was singled out as being "high performing" in gastroenterology and other medical specialties.

Once the dust settles at Exeter, it must follow Forbes' public health crisis management approach to truly right the ship and restore its public image. Above all, it must keep the conversation going. Farah and Rubino say it best: "Talking about any incident can be beneficial, just as keeping patients informed can never be wrong."

Marianne Aiello is a contributing writer at HealthLeaders Media.

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