Impacts Related to Unsafe Injection Practices

The impact of a single outbreak related to unsafe injection practices in a healthcare setting can be devastating on many levels. If your health department is concerned that it lacks the money and staff to sign on to the One & Only Campaign, consider the cost of inaction and what could happen if your department were to be drawn into a time-consuming outbreak investigation.

Economic Impact – Public Health
A 2008 Nevada outbreak associated with an endoscopy clinic is a good case in point. Hepatitis C transmission is believed to have occurred through reuse of syringes to access medication vials that were then used for subsequent patients at a Nevada endoscopy facility. The Southern Nevada Health District (SNHD) estimated total public health costs including investigation, testing, and medical counseling at $16-$21 million. The full report of the investigation and findings are available through the SNHD website at

Investigation of a 2009 New Jersey hepatitis B outbreak associated with an oncology practice involved staff from multiple areas in the state health department, including representatives from the communicable disease service, environmental health, public health environmental and agricultural laboratories, and the office of communications/press office. The local health department and community hospital also had many staff involved in the investigation. Additional departments and state agencies involved included Law, Public Safety (consumer and health professional boards, enforcement), and the Department of Banking & Insurance. Significant staff time and resources were expended during the investigation, patient notification and testing phase, as well as the follow-up. It is difficult to determine the number of staff hours and resources that were dedicated to the investigation and response, but it is clear that many staff were pulled from other projects to assist with the outbreak. Three years after the conclusion of the investigation, state health department staff are still involved with aspects of the investigation.

Economic Impact – Healthcare Provider
The doctor and two nurses involved in the 2008 Nevada hepatitis C outbreak face not only a loss of livelihood and reputation, but also criminal charges that their malpractice insurance does not cover. Their legal fees are out-of-pocket.

The manufacturer of the drug Propofol, which was misused in a hepatitis C outbreak in Nevada, have settled most of the lawsuits related to the outbreak. The company has earmarked $285 million to settle approximately 120 lawsuits, with 15 lawsuits remaining open over this matter. The suits are related to the 50 ml size of the single-use medication vials and their contribution to the outbreak.  (See full story at:

In New Jersey, a physician who was implicated in an outbreak of hepatitis B among his patients lost his medical license and paid $30,000 in civil penalties.

Emotional Impact – A Personal Perspective
Dr. Evelyn McKnight is a nationally-recognized patient safety advocate and survivor of one of the largest viral hepatitis outbreaks in American healthcare history. (Learn more at: She turned her personal tragedy into a crusade to save lives. As co-founder and president of Hepatitis Outbreaks’ National Organization for Reform (HONOReform). Dr. McKnight developed a self-narrated safe injections presentation, A Never Event: The Patient Perspective. HONOReform is a national advocacy organization dedicated to protecting patients from unsafe injections. Learn more and view the presentation at their website:

Economic Impact – Patient
Patients face a high cost dealing with the burden of illness. Consider just the economic impact:

  • Costs for treatment
  • Loss of income
  • Costs related to litigation