Days after health officials announced their theories behind how six people contracted hepatitis C at a Las Vegas endoscopy center, Nevadans turned to their health care providers and asked: "Do you reuse syringes and needles?"
Some patients didn't bother to go that far. They simply canceled appointments or optional surgical procedures. Even nurses at Southern Nevada Health District immunization clinics found themselves trying to reassure parents no harm would come to their children while receiving vaccines.
Over the past four months, health officials have worked to restore the public's trust in medical care.
Some health care providers are taking unusual approaches. At Steinberg Diagnostic Medical Imaging Centers, patients are handed cards that inform them the facility "never reuses needles or syringes." Other providers explain to patients how medical equipment works and is sterilized.
"The loss of confidence is large, and we've tried to be responsive at all the various levels necessary to restore confidence,'' said Larry Matheis, head of the Nevada State Medical Association.
"People are really nervous," said Dawn Hughes, director of surgical services at Sunrise Hospital. "They say, 'I know what happened.' We just try to reassure them that won't happen here.''
Hughes said patients are asking a lot of questions. In most cases, hospital staff will walk patients through procedures and offer to show them equipment that will be used. Patients also want to see packaging of syringes, she said.
Though that was the practice of Sunrise Health hospitals in the past, staff has been more diligent since news of the hepatitis C outbreak, Hughes said.
"One of the greatest strides we've made over the last 10 years is to get people to do screening for colonoscopies,'' Hughes said. "We sure don't want people avoiding them because of something like this.''
Stephanie Bethel, a health district spokeswoman, said nurses must explain to parents that syringes and needles are not being reused.
The health district uses a particular syringe, VanishPoint, in which the needle retracts into the syringe's barrel after use.
"We have been showing patients how that works,'' Bethel said.
Matheis said physicians must take a "please ask me" approach. In other words, "We want to encourage doctors not to wait for a patient to ask questions but to assume the patient has questions.''
Matheis said physicians must be comfortable with their own infection control standards and procedures before they can offer reassurance to patients.
"We've encouraged physicians to address this as they feel most comfortable,'' Matheis said. "That's led to some innovative efforts like those at Steinberg. ... The hardest thing for many physicians is the growing number of patients who are concerned about referrals to certain specialists.''
Matheis said most patients are referred to specialists such as gastroenterologists by primary care physicians. He said primary care physicians are taking the lead on educating the public about health care safety issues and what questions to ask specialists about procedures and equipment being used.
The Centers for Disease Control and Prevention and health district investigators believe hepatitis C was spread to patients at the Endoscopy Center of Southern Nevada, 700 Shadow Lane, after nurse anesthetists reused syringes and single dose vials of anesthesia.
Initially, health officials notified 40,000 former patients of the endoscopy center they should be tested for blood borne diseases. That increased to just over 50,000 as health officials acquired more accurate patient records.
Eight hepatitis C cases have been linked to two clinics affiliated with the endoscopy center. Another 77 have tested positive for hepatitis C, and their disease may be linked to the Shadow Lane facility as well, health officials say. Several investigations are under way.
Dr. Jerry Jones, a Las Vegas OB-GYN and president of the Clark County Medical Society, said the organization has started a column in its monthly newsletter on medical safety to aid physicians. The group also plans to publish about a dozen articles on the issue.
The state's medical association is working with HONOReform -- a national advocacy group for patients who become infected with hepatitis in health care facilities -- and the Centers for Disease Control and Prevention Foundation to develop a national campaign to ensure injection safety in health care settings nationwide.
Matheis said Nevada's physicians will be the first to pilot a national campaign on injection safety by developing fliers, posters, patient information sheets and creating educational programs for doctors. The campaign is expected to begin nationally by early next year.
"This is probably the first full-blown campaign on this issue since the start of the HIV and AIDS epidemic. A lot of information has changed, and a lot of technology.''
The medical association is also working with the Nevada Center for Ethics and Health Policy to hold a professional ethics summit this fall addressing issues raised by the public, lawmakers and the medical community as a result of the hepatitis C outbreak.
Sally Hardwick, the center's project coordinator, said the forum would look at how to restore the public's trust as well as the quality of care in Nevada.
"We want to build a health care community that really endorses high ethical standards,'' she said. "We really need the public to know that we're all concerned and we're working hard to restore their trust.''
Contact reporter Annette Wells at awells @reviewjournal.com or 702-383-0283.