"We caution that this is probably just the tip of the iceberg because there are so many issues with detection bias and lack of sensitivity in terms of actually picking up an outbreak and having it reported to the health department and investigated fully," he said. "Many hepatitis cases are, unfortunately, unexplained, and it's an issue that we need to get ahead of."
Perz outlined three myths that he says are pervasive among providers, highlighting the urgent need for education.
1. Contamination of injection devices is limited to the needle.
"This is a technology that's over a century old, but there's a perception that the needle becomes contaminated when used on a patient, but there's the lack of awareness that the needle and syringe are one unit. Removing a needle does not make the syringe safe for use, and in fact, that's a very, very dangerous practice."
2. The presence of some intravenous tubing or a valve prevents backflow and contamination of injection devices. "That's always false. We need to consider everything, from the needle and syringe or the medication bag all the way to the patient as a single, interconnected unit, and take great caution to avoid any temptation to reuse syringes in that context."
3. If there's no blood, there's no risk. "People forget that germs are not visible to the naked eye. We've unfortunately have encountered situations where healthcare workers thought they somehow had a sterile field because they were injecting through a short length of IV tubing and only saw clear fluid. That's another dangerous myth."
He added that needles and syringes should always be thought of as single-use devices, never used for more than one patient or reused to draw up medication. Healthcare workers should not administer medications from a single dose vial or IV bag to multiple patients and multi-dose vials should be eliminated or dedicated to single patients whenever possible.
Susan Dolan, epidemiologist with the Children's Hospital in Denver, said safe medication use is tougher for some hospitals that may be resource-strapped.