Home E-Weekly May 16, 2017

What Caused 40 Patients to Develop Septic Arthritis of the Knee?

Published: May 15, 2017

KNEE DEEP Forty patients developed septic arthritis of the knee after being given hyaluronic acid injections at a New Jersey pain clinic.

From not washing their hands between treating patients to reusing single-use vials of an injectable contrast agent, doctors at a New Jersey pain clinic routinely failed to follow basic infection-related protocols while administering hyaluronic acid injections for knee pain, says a scathing report from the state's Department of Health.

The Osteo Relief Institute of Jersey Shore in Wall Twp., which had been treating up to 85 patients a day, voluntarily closed for 2 weeks in March, according to news reports, but has since reopened. Forty patients developed septic arthritis of the knee after being given knee injections; 29 of the 40 later required surgery. All 40 patients received injections of lidocaine 1% and Omnipaque 300 contrast agent. At least 35 of 40 patients received injections of viscosupplement (various types). The various viscosupplements in pre-filled sterile syringes were no longer outside of sterile packaging but were taken out of their boxes and placed in clear plastic bins in advance of treatment, thereby exposing the medications to light, according to the report.

Among the findings detailed in the health department report: A single-dose vial of the contrast agent Omnipaque 300 was used for up to 50 knee injections; sterile needles and syringes were opened in advance and stored in bins; multiple-dose vials weren't labeled or dated; and an exam table that was cleaned no more than once a day was used as the surface for medication preparation.

Additionally, one physician, Mariam Rubbani, MD, reportedly told investigators that she rarely checked patients' vital signs, and that she didn't wash her hands between patients, because she wore non-sterile gloves while administering injections. Staff told investigators that they used hand sanitizer, but none was available in the clinic, according to the report.

Dr. Rubbani, who has since resigned from the clinic, could not be reached for comment. The clinic did not return a call from Outpatient Surgery.

Jim Burger

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