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August 10. 2012 1:55AM
Updated: Hepatitis report faults Exeter Hospital
CONCORD — A state health official has confirmed to the New Hampshire Union Leader that the Exeter Hospital employee who came to work with "draining wounds," described in a report that cites the hospital for numerous violations, was David Kwiatkowski.
Kwiatkowski is the medical technician accused of spreading hepatitis C to at least 31 patients of Exeter Hospital’s cardiac catheterization lab through contaminated syringes.
A report released by the state health department and federal Centers for Medicare & Medicaid Services (CMS) on Thursday cited the hospital for clinical and life safety violations, including failure to secure controlled medications — and "allowing an employee with draining wounds to participate in an environment where invasive medical procedures were being performed."
A team from the state health department’s health facilities certification unit went to that hospital in June and again in July after the hepatitis C outbreak was reported. Its inspection found that syringes filled with medication were placed on a medication cart while workers who were not authorized to handle medications were in the room — "including the cardiac cath technicians."
Kwiatkowski, 33, was arrested in July on federal charges for allegedly stealing syringes filled with narcotics and replacing them with contaminated syringes. Kwiatkowski worked in the hospital’s cardiac catheterization lab from April, 2011, until May 16 of this year.
According to the report, state inspectors who interviewed the manager of the cath lab on June 7 were told that a scrub technician they call "Staff B," who had "3 open lesions and a finger cut that needed stitches," was asked to leave the work area several times "due to weeping/discharge of fluids and bloodlike stains in (his) scrubs (clothing), including at least once during a procedure."
The employee is not named in the report. However, John Martin, manager of the Bureau of Licensing and Certification at the state health department, confirmed that "Staff B" was Kwiatkowski.
In a statement released Friday, Exeter Hospital officials said after an investigation uncovered alleged drug diversion by an "ex-employee," they modified the preparation process for pain medication as of June 12. "Once filled, syringes are locked up by a nurse until the moment they are needed and only then are they unlocked," it stated.
Inspectors found the hospital "failed to provide a sanitary environment, and avoid sources of transmission of potential infections." They cited the hospital for "allowing an employee with draining wounds to participate in an environment where invasive procedures were being performed."
The state/CMS report also cited Exeter Hospital for having no consistent methodology for cleaning and disinfecting glucometers after each patient use.
The inspection team also found the hospital failed to follow "recognized standards" for:
-- cleaning and disinfecting equipment between patient uses "on five of seven distinct hospital areas;"
-- "appropriate gowning when entering the room of a patient on infection precaution" in one area;
-- and "criteria for employees with potential infectious process for being able to work in direct patient care."
Martin explained an initial, limited survey was conducted in June after Exeter Hospital self-reported in May that there were hepatitis C cases associated with its cardiac catheterization lab. That inspection, which was limited to areas of quality of care, physical environment and infection control, "did find some areas of noncompliance," he said.
After that survey report was completed, the Centers for Medicare & Medicaid Services asked the state to go back to the hospital and conduct a full survey.
"It’s the kind of survey we do if we were renewing a license for a facility," Martin explained.
In response to the citations, the hospital has changed its policy for securing drugs, requiring a nurse to place filled syringes into a locked drawer, according to the report.
The hospital also promised to review its policies on infection precaution, to monitor compliance and to establish criteria for employees with "lesions or weeping dermatitis" to refrain from all direct patient care.
The state inspectors prepared a report and sent it to Exeter Hospital officials, who were required to prepare a "plan of corrections." That plan was finalized Thursday, and the state released the documents later that day.
Now, Martin said, Exeter Hospital has to carry out its plan of correction, "identifying how they’re going to correct each of the cited deficiencies."
Shawne Wickham may be reached at swickham@unionleader.com.
Kwiatkowski is the medical technician accused of spreading hepatitis C to at least 31 patients of Exeter Hospital’s cardiac catheterization lab through contaminated syringes.
A report released by the state health department and federal Centers for Medicare & Medicaid Services (CMS) on Thursday cited the hospital for clinical and life safety violations, including failure to secure controlled medications — and "allowing an employee with draining wounds to participate in an environment where invasive medical procedures were being performed."
A team from the state health department’s health facilities certification unit went to that hospital in June and again in July after the hepatitis C outbreak was reported. Its inspection found that syringes filled with medication were placed on a medication cart while workers who were not authorized to handle medications were in the room — "including the cardiac cath technicians."
Kwiatkowski, 33, was arrested in July on federal charges for allegedly stealing syringes filled with narcotics and replacing them with contaminated syringes. Kwiatkowski worked in the hospital’s cardiac catheterization lab from April, 2011, until May 16 of this year.
According to the report, state inspectors who interviewed the manager of the cath lab on June 7 were told that a scrub technician they call "Staff B," who had "3 open lesions and a finger cut that needed stitches," was asked to leave the work area several times "due to weeping/discharge of fluids and bloodlike stains in (his) scrubs (clothing), including at least once during a procedure."
The employee is not named in the report. However, John Martin, manager of the Bureau of Licensing and Certification at the state health department, confirmed that "Staff B" was Kwiatkowski.
In a statement released Friday, Exeter Hospital officials said after an investigation uncovered alleged drug diversion by an "ex-employee," they modified the preparation process for pain medication as of June 12. "Once filled, syringes are locked up by a nurse until the moment they are needed and only then are they unlocked," it stated.
Inspectors found the hospital "failed to provide a sanitary environment, and avoid sources of transmission of potential infections." They cited the hospital for "allowing an employee with draining wounds to participate in an environment where invasive procedures were being performed."
The state/CMS report also cited Exeter Hospital for having no consistent methodology for cleaning and disinfecting glucometers after each patient use.
The inspection team also found the hospital failed to follow "recognized standards" for:
-- cleaning and disinfecting equipment between patient uses "on five of seven distinct hospital areas;"
-- "appropriate gowning when entering the room of a patient on infection precaution" in one area;
-- and "criteria for employees with potential infectious process for being able to work in direct patient care."
Martin explained an initial, limited survey was conducted in June after Exeter Hospital self-reported in May that there were hepatitis C cases associated with its cardiac catheterization lab. That inspection, which was limited to areas of quality of care, physical environment and infection control, "did find some areas of noncompliance," he said.
After that survey report was completed, the Centers for Medicare & Medicaid Services asked the state to go back to the hospital and conduct a full survey.
"It’s the kind of survey we do if we were renewing a license for a facility," Martin explained.
In response to the citations, the hospital has changed its policy for securing drugs, requiring a nurse to place filled syringes into a locked drawer, according to the report.
The hospital also promised to review its policies on infection precaution, to monitor compliance and to establish criteria for employees with "lesions or weeping dermatitis" to refrain from all direct patient care.
The state inspectors prepared a report and sent it to Exeter Hospital officials, who were required to prepare a "plan of corrections." That plan was finalized Thursday, and the state released the documents later that day.
Now, Martin said, Exeter Hospital has to carry out its plan of correction, "identifying how they’re going to correct each of the cited deficiencies."
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Shawne Wickham may be reached at swickham@unionleader.com.
