How multi-dose vials (MDVs) and insulin pens can be contaminated with HCV

Multi-dose vials hcv

Multi-dose vial contamination with HCV
Source: Web image Clarke County Health Dept./Mike Johnson

Patient-to-patient contamination with multi-dose vials

This is how I interpret the image above:

1.  Syringe and needle draw fluid from a multi-dose vial (MDV).  A patient with HCV is injected.  Microscopic blood cells can backflow into the syringe.

2.  Needle # 1 is discarded.  Needle #2, a new needle, is attached to the contaminated syringe.

3.  Fluid is withdrawn from a 2nd vial.  Microscopic blood travels into the 2nd multi-dose vial.

4.  Needle and syringe are discarded.  However, the 2nd multi-dose vial is now contaminated.

5.  When a new patient is injected with fluid from the 2nd vial, they are at risk for HCV infection.

A few injection safety rules from the CDC for professionals when MDVs must be used:

“If multiple-dose vials are used, restrict them to a centralized medication area or for single patient use. Never reenter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient.”

The brief video posted previously in ASKNOD about The One and Only One campaign reinforces these concepts.  Also check out the CDC site: http://www.oneandonlycampaign.org/

These same safety concepts can be applied to insulin pens because blood and skin cells enter the insulin cartridges as well.  This 3-minute CDC video explains:

And this is basically how jet-gun injectors with “on tool” multi-dose vials were contaminated as well.  

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PRE-VALENTINE HUMOR.

News and film from member WYn Wn . Just in time for the Six o’clock report on the Left Coast.

About an hour after Last Call at the VFW bar, several old geezers were checking out their buddy’s new apartment. Needless to say, like good Army buddies everywhere, they’d had waaaay too much snakebite medicine.

Vet #1 says”Come on back here you guys. You gotta check this puppy out. ”

Along the wall in his bedroom is a massive gong and a heavy mallet. Vet# 2 says:

“Dude. What’s with the mega-gong?”

ATT00001

The proud owner nods his head in disagreement and says:

“No way. Itza talkn’ clock, man. Had me fooled.  My daughter got it at Walmart, I think.”

Vet #3 observes to Vet #2:

“Man, he’s charcoal. Talking clock, my ass.”

Vet#1 immediately raises his finger and says:” Whoa. Check it out. ”

With that, he grabs up the mallet and puts the hurt on the plate.

Several moments go by while they all look at each other blankly as only drunk guys can. Suddenly from the other side of the wall comes a scream of biblical proportions:

“You ASSHOLE! It’s three fifteen in the morning!”

Vet #2 looks over at Vet #3 knowingly and says:

“Yep. Know where I’m gonna be headin’ tomorrow morning.  Mmmhmm, Walmart, dude”.

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OraQuick® HCV Rapid Antibody Test

oraquick hcv raipd  test

This should be in every doctor’s office.  It was used in Exeter, NH during the recent HCV outbreak.  It’s FDA approved to detect HCV in fingerstick blood or whole blood with results in 20 minutes.  

HCV rapid test Reimbursement & Coding Guide.pdf

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COGNITIVE DYSFUNCTION IN VETS

Remember the milk commercial where the gal says “I can’t believe you didn’t tell me.” and the husband says “Is this about the time I did in prison?” Member Tom of USS Long Beach fame sends us this classic…

A middle-aged  Vet is shopping at Safeway and notices a good-looking gal waving at him. As he walks over, she greets him.

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He’s rather taken aback because he can’t place where he knows her from.

 

So he asks, ‘Do you know me?’

 

To which she replies, ‘I think you’re the father of one of my kids.’

 

Now his mind travels back to the only time he had ever been unfaithful to his wife. Knowing he was way too drunk to remember the face, he asks, ‘Were you the stripper from Randy’s sendoff party on his fourth deployment? That one where we made love on the pool table, with all my buddies cheering, while your partner whipped my butt with wet celery?’

 

She looks into his eyes and says calmly, ‘No, I don’t believe so. I’m your son’s teacher.’

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CAPITALIZING ON THE INSULIN PEN

Remember good ol’ boy Rahm “The Rahmrod” Emanuel of Casa Blanca Fame? He was the White House chief of staff in the President’s first administration. He was best remembered for his famous election plaint “Never let a good catastrophe go to waste”. I don’t know how he can exploit the Connecticut thing in Chicago.  In fact, Rahm and the windy city lost 446 kids there to gunfire in 2012. Sandy Hook pales in comparison but that’s not why I called your here.

As you know, any good catastrophe has a silver lining somewhere and what Senator Schumer is doing is barking up our tree. He’s drawing attention to something (IV cross-contamination) that we’ve been trying to prove for scores of years about jetguns, dental surgery and other medical misfeasance that involves “sharing” in a supposedly sterile environment. We now have a second instance (in New York again, no less) of recycling Insulpens. Consider this  below:

As was the case in Buffalo, needles were changed with each use of the insulin pens, the Olean hospital said. The risk of infection remained, however, because stored insulin in the pen cartridge could have become contaminated by a back flow of blood with each use.

“We are very aware that while the risk of infection from insulin pen re-use is extremely small, cross-contamination from an insulin pen is possible,” Finan said.

Federal health agencies have been warning against sharing insulin pens for several years. The Food and Drug Administration issued an alert in March 2009 after learning that more than 2,000 patients may have been exposed at a Texas hospital between 2007 and 2009.

When we file claims for HCV, one of the risks most Vets are sure to include is the venerable jetgun. The logic is obvious so I won’t go into it. The Dayton VAMC dental disaster is more valuable evidence to submit that Murphy’s Law is current and up to date. In short, all the risks are listed and examined. VA, as we all know, are like the venerable three monkeys and thus immune to logic.

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What then, when presented with a Federal guideline on the care and feeding of Insulin pens, is the VA to say about the sanitary efficacy of their much-touted medical system? In 2012, not 1968. For decades they have poo-pooed the mere idea that military medical personnel, let alone VA personnel, would even endanger our health by cutting corners. Field hospitals in Vietnam-mere triage centers on the way to meaningful medical help- were as sterile as modern-day hospital settings. Syringes to administer shots were never reused. Morphine styrettes were never, ever used on more than one soldier. Jet guns were carefully wiped with alcohol in between shots and were immediately autoclaved if one spot of blood was observed.  NOT. I remember the “autoclave” at the CIA’s USAID hospital in Ban Sam Thong in the fall of 1970. It consisted of a steel pan also used to boil water in for coffee in the morning. No lid. The syringes were glass, not throwaway disposables. The needles were few and far between. You reused them by sharpening them on the flint of a match pack. I know. I watched this personally. It was being done by a Thai doctor, not a peckerchecker. Don’t talk to me about sanitary protocols by doctors.  I’ll have none of that.

The silver lining is that VA has once  again stepped on their necktie. They didn’t have a mea culpa moment. The VAOIG showed up and said : “Whoaaaa. Back the boat back up to the dock, Gilligan. We have a problem here. That’s against the law in 48 states.” Now it’s out in the open like Dayton. This,  when added to the growing avalanche of evidence already piling up, is fresh in the minds of judges. If DoD decided jet guns were impossible to keep contamination-free, a lazy VA dentist singlehandedly infected six Vets, a former VA employee (nurse) singlehandedly infected 32 souls, and an Insulin pen is regularly being used on multiple patients even now in 2012, it’s safe to say that the odds of getting this are not only plausible but have been migrating up several notches over the years.

Each time this occurs, VA is quick to pull some number or percentage out of their hat and say “Hey, what are we talking here? Six Vets out of how many? It’s like less than one half of one percent of 10,000. We can safely say this was just an aberration that statistically happens like a one hundred year storm.” When it happens twice in a year, perhaps it’s an unfortunate fluke. All bets are off when the snowball gets so big it develops a life of its own. This has now turned into the eight hundred pound gorilla that even the VA is going to have a hard time wrestling off the sofa.

Letting this catastrophe go to waste is nonsensical. If the federal Government, in the guise of Federal Health agencies, felt they were obligated to point out the potential for contamination several years prior, imagine the stupid look VA should have on it’s face? Remember the colonoscopies down in Florida that cross-contaminated Vets with HCV? Put it in as evidence. The VA Nurse cum junkie who stole syringes and reloaded them with saline after he injected? Mention it and provide the link. Each instance reveals another viable pathway to a risk. VA’s reuse of the Insulin pens will be seen as one more nail in what can be deemed a veritable pincushion of  a coffin.

Once the presumption of sanitary protocols is rebutted, the introduction of benefit of the doubt can enter in. Plausible, as envisaged in the 2004 FAST letter, takes on a new cachet. VA’s reluctance to test even one Ped-o-jet for all these many years no longer holds sway. Their own stupidity and a “use it again, Sam” mentality have finally rebutted what they have held to be gospel for a century. A Vet would be a fool to let this be swept under the carpet.

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SENATOR SEEKS TESTING OF VETS

Member John of Vermont sticky stuff sends us this. Senator Schumer (D-NY) came out today and advocated for Vets. More specifically, in light of the sanitary protocols breakdown at the Buffalo VAMC, he suggested it might be a good idea to start testing Vets… and their families.

This is something we’ve been trying to get accomplished for for nigh on 15 years to no avail. More recently, the VA has at least opted to offer testing for HIV. That’s a step in the right direction but HIV wasn’t rampant in the population, let alone the Veteran population, during the period of jetgun usage (1958-1998). These are the Veterans at greatest risk but they aren’t tested unless they ask to be. Considering that homosexuality was considered a personality disorder subject to immediate separation until DADT, it’s almost foolish to squander valuable medical resources to pursue that avenue of disease. HBV and HCV were the biggest danger for that universe of Veterans.

Considering that VA wants to know everything they can about us, I find it strangely odd that they wouldn’t extend their line of inquiry to HCV. As it now stands, when we go in for an appointment we are quizzed unmercifully about our state of mind and whether we are depressed. I noticed a member (Mark) posted recently and informed me he was grilled extensively about whether he had guns in his home. This resulted in a deal breaker. He got up and left without completing his mission. I would have too. It would be interesting to see what is entered in the VISTA computer about that visit.  VA has no reason to harvest this kind of information on us without some kind of predicate.

Thank you Sen. Schumer for your concern about your constituent Vets in Buffalo. Would that you evinced this concern all the time for all Vets in America.

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FOOTLOCKER– APRÈS VIETNAM

When I returned home, the Air Force decided they didn’t like me anymore. I had gone native and no longer shined my shoes after two years in the sticks. Hair was another issue which became a deal breaker. We parted company in February of 1973 and I went on to drive a cab for Lancaster, California Yellow Cab. That didn’t pan out so I went down to Bermite Powder Co. and applied for a job. Anyone could get a job there And you could meet babes.  I knew no one so this was the perfect social climber job.The other place across the way was Space Ordnance Systems (SOS). It’s title accurately described it. Explosives were their specialty but OSHA safety was several decades away. They used giant mixmasters  to combine lead azide ( a precursor to nitroglycerin). Lead azide was only marginally more stable that the nitro and the Santa Clarita canyon would resonate with a good, solid boom every time one of their mixers went up. They normally were crewed by three guys. Every time they had an explosion, the employment office would post in increments of three.

It was extremely dry and humidity was always low there. The conditions were perfect for making and mixing gunpowder. Unfortunately, those very same conditions caused a lot of static electricity to build up on things. If you reached to touch a piece of equipment, a spark always jumped across. We were all forced to wear a grounding bracelet that connected us to a ground wire. It looked like a leather wrist band with 4 feet of an 18 gauge wire than terminated in an alligator clip- quite handy as a roachclip in those days.

Due to the strenuous conditions and moving around large quantities of the azide meant disconnecting from the grounding system. Failure to “pre-ground” before coming in contact with the mixers was what caused a lot of SOS’ problems. The pay was the same at both places but Bermite was much bigger. This was the height of the Vietnam War. Business was booming at both joints and there was heavy turnover every time something went boom. Something about flying bodies turns off some people. Top pay over at Bermite was as a mechanic for $3.05/hr. That was my calling.

Bermite was building and assembling 60mm and 81 mm mortar flares. In addition,  they manufactured the 505 fuse assembly for 155mm artillery shells. The fuses had our old friend lead azide in them. On break one day in November 73, I watched a fellow take a large tray of these out of a bunker and begin to carry them into the assembly bunker. Bunkers were designed to send explosions vertically inside “explosion walls” to avoid blowing up other buildings adjacent. We all wore aprons to keep azide and magnesium powder from accumulating on our clothes. Nothing was done about shoes.

The fellow had his apron strings untied and tripped over one of them. The aftermath was predictable  He dumped the whole tray on the ground and the explosion obliterated him. We were 30 yards away and it parted our hair. He lasted about 5 minutes-not even enough time for the meat wagon to arrive.. This happened a lot. The 332 building assembled the rocket motors for Sidewinder missiles. It went up in smoke due to “unknown” just before I began working there. My future bride’s sister lost her new husband in that one and became an instant lotto winner for his SSI.

I worked mostly in the 335 building on the line drilling and pinning the tail cones onto the mortar bodies. We only had one scare when a guy dropped one at the end of the line and the propellant went off. It ignited a lot of spilled powder on the floor for 15 minutes and everyone bugged out. Well, almost everyone. I was the lead man on the line so I ran to the explosion. I wrapped my apron around the flare and ran outside dumping it in a half shell 55 gal. tub full of water. The magnesium hadn’t ignited or it would have been a wasted effort. I was almost demoted for that. I violated protocol by running in the wrong direction. I never even got a thank you Nod letter for saving 335.

We used to “requisition” the 81 mm candles and take them home for entertainment. They’d turn night into day for 5 minutes. You could put them in the old fashioned phone booths and slag them down to the pavement. We even took a bunch up to Barstow to my future intended’s 160 acre ranch and lit them off on their dry lake bed. I’m sure this is what prompted all the calls in about UFOs. Army choppers from nearby Fort Irwin would buzz the place for days afterwards.

There were mudpots on the southwest side of the lake. They were liquid vents of boiling mud much like quicksand. You could light a candle and toss them in by their steel parachute lanyard and make the pots belch like mud volcanoes.

The 505 fuses were a different story. There was no safe way to ignite them. My room mate Gary opened one with his trusty P-38 can opener and tried to light it with his Zippo. It  blew all the skin off the back of his hand and didn’t even make a decent boom. I had to drive him to the hospital because he went into shock. What a pussy.

My next door neighbors had a Christmas party and someone who worked in the slurry building had her feet up on the living room table. In the waffle stomper pattern of her boots was almost a pound of dried flare slurry. We dug it all out with car keys and filled the big ash tray on the table with it. It burned the ceiling when we finally got it to ignite. Young folks did stupid things way back then. Working around high explosives was, to me, an opportunity to get all kinds of neat stuff. The C-4 used to propel the 60 mm mortars was a case in point. If you collected enough of the little sewn-together sheets and made a pipe bomb out of it, you could almost send an upside down wheel barrow into orbit.

At a  2008 gun show meet in Puyallup, I spotted one of the 81mm candles for sale. The guy had no clue what he was holding. He took it back to his car after I explained what it was capable of. As you can see, Bermite went out of business in 1987- 14 years after I moved up to Seattle. The odds just weren’t in it to keep working at either outfit. You’d draw the short stick eventually and the money sucked. SOS didn’t fare any better. The best job at either outfit was EOD. We all volunteered for that. You’d drive from building to building in a company truck with a huge piece of braided metal hanging off the axle and touching the ground underneath to keep it grounded. At each building you’d collect all the damaged or misconstructed explosives and cart them to the disposal area in a remote canyon. We’d usually ignite it with a quarter stick of Dupont 40 stump dynamite and a 20 second quick match. Someone decide it was too dangerous so they switched over to detcord just before I left. Those were the good old days.

Here’s a picture of the Bermite Co. housing my future first wife was living in when I met her:

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AFGE OUTTAKES

An AFGE photographer just sent me this outtake he was getting ready to throw away. Fortunately he decided immortalizing one of VA’s finest Human Resources managers on celluloid was almost a crime to pass up. Hence I received this.

Apparently the unnamed  VA employee in higher management had not received enough of the Holy Sacrament near the ice sculpture and misplaced her glass. New member Ron has earned his stripes today for what may become the poster child of Orlando.

2013-01-23 235823

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Hep C maps: Access BIG data online

hcv map

Map Hep C
source: National Minority Quality Forum

For an overview of HCV demographics, register (name, email, password), agree to “personal use only” of the mapping application, and you can explore HCV prevalence and hospitalization data to 2006.   You can drill down by zip code or whatever parameters you are interested in.  You can search by legislative district too.

I found the site while thinking about the much higher rates of HCV in males for the 45-65 year old demographics.  I think this can be explained, in part, by the fact that very few females joined the military 40 years ago when compared to males.

August 4, 1964 – January 27, 1973
Total who served in all Armed Forces:
 8,744,000

Deployed to Southeast Asia: 3,403,000

In comparison, a VA 2009 press release states:

“About 250,000 women Veterans served in the military during the Vietnam War and about 7,000 were in or near Vietnam.

The VA is requesting about 10,000 female Vietnam Era veterans to participate in a four-year health study.

Those who were in Vietnam, those who served elsewhere in Southeast Asia and those who served in the United States are potential study participants.”

It will be interesting to see the results of this study since the women who did serve were often exposed to blood as healthcare workers.

Ed. note: It would be nice if this site also delves into genotype by geographical distribution in the sixties and seventies to show the predilection for 3A on the Indochinese Peninsula, 2A and 2B  distribution in Korea and Japan, 1B in Europe and of course 1A in the US.

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GARAGE DOORS FOR VETS

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This just in from Da Nang Tombo. Everyone wants that unique signature look-one that no one else on the block would dare  copy. Vets, of course, march to the beat of a different drummer. Yes, no ordinary garage door closure will give them that je ne sais quoi they crave more than one of these babies from VETDOORS™.

Imagine pulling up and hitting the opener knowing all your neighbors are drooling with envy. Witness the TV Vans cruising the block looking at your door. Crime will decrease immediately and there will be noticeably less car and pedestrian traffic in your environs.

Choose from these exciting themes:

Air Force 1

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Air Force 2 for the Covert Tactical bunch

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Air Force 3 for the free-spirited:

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Army/ Marines Heavy Metal types.

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Navy (Brown Water)

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Retired AirAm PICs

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See-Bees

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Homesick homies from Pacoima Lowriders Association stationed at Fort Lewis

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$499.00–FOB Detroit. Dealer prep and destination fees may be extra; Fuel Surcharge Mon.-Friday; Insurance is the responsibility of the purchasor: Not responsible for accidents, drive-by shootings or drunks injured by depictions. All images are copyrighted and intellectual property of VETDOORS™. Custom door designs available on request. Aircraft are merely symbolizations and no warranty as to their airworthiness is created or implied in a contract to purchase. Images are not to scale.

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