As many as seven patients at a Santa Barbara, Calif., clinic offering prolotherapy developed hepatitis C virus infections, leading its closure last year after inspections disclosed a variety of unsafe injection practices, CDC and local officials reported.
In administering treatment, the physician delivering the therapy was reported to have breached infection control procedures by "reentering multidose medication vials with a used syringe, use of single-dose medication vials for multiple patients, poor hand hygiene and inconsistent glove use, and lack of aseptic technique when handling injection equipment and medication," according to officials' final report on the outbreak published Thursday.
The episode highlights the need for clinicians in all types of healthcare settings to follow safe practices for administering injections, the officials said.
Prolotherapy is a newly popular treatment for chronic musculoskeletal pain which involves injecting patients with various substances such as hypertonic dextrose, phenol-glycerine-glucose, morrhuate sodium, and sometimes platelet-rich plasma. The injections are supposed to mitigate pain levels and cause tissue regeneration.
According to the report, an initial patient was treated with prolotherapy very close to the time of HCV diagnosis in late 2014. Investigators determined that the injection-based treatment likely caused the infection.
Other patients who had visited the same clinic over the preceding 10 months were made aware of their potential exposure to HCV, and encouraged to get tested. Six cases of HCV infection were identified, five of which were new.
The MMWR report did not identify the clinic by name, but indicated that it belonged to Allen J. Thomashefsky, MD.
Thomashefsky's office in Santa Barbara remains closed. However, he also had a second practice in Ashland, Ore., which is still listed as open by the Oregon Medical Board, and his state license remains active.
The Oregon board's website indicates that five orders have been filed against Thomashefsky, three of which remain open. One of these orders was a "Complaint and Notice," which accused Thomashefsky of engaging in "unprofessional or dishonorable conduct" and of displaying "negligence."
Thomashefsky did not respond to a 51˶ request for comment.
Primary Source
Morbidity and Mortality Weekly Report
Foster, A et al "Investigation of hepatitis c virus transmission associated with injection therapy for chronic pain -- california, 2015" MMWR 2016; 65(21): 547-549.