VA Inspections Show Continued Flaws
June 16, 2009
A report by the Veterans' Administration's inspector general finds less than half of the VA facilities given a surprise inspection last month had appropriate training and guidelines in place for common endoscopic procedures, suggesting the recently disclosed errors that potentially exposed thousands of veterans to HIV and hepatitis may be more widespread than initially thought.
The inspector general's investigation follows the discovery of improper handling of endoscopy equipment at the VA hospital in Murfreesboro, Tenn., which led to a nationwide safety campaign at all of the agency's 153 medical centers. Mistakes were also identified at facilities in Miami and Augusta, Ga., prompting the notification that about 10,000 former patients at the three sites should get blood tests for HIV and hepatitis.
In Murfreesboro, officials believe the use of a wrong valve may have allowed body fluid residue to transfer from patient to patient, stemming back to 2003. In Miami, a tube that should have been cleaned after each colonoscopy was instead cleaned at the end of the day, affecting patients between May 2004 and March 2009. In Augusta, ear nose and throat scopes were improperly sterilized from January to November 2008.
In a statement, VA spokesperson Katie Roberts said the agency is taking aggressive action to ensure that each facility is in compliance with correct standard operating procedures.
06.16.2009; Kimberly Hefling; Ben Evans
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.