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May 2014 VA Hep C Treatment Guidelines
UPDATE: Feb 26, 2016-
Funding and Prioritization Status Update

UPDATE: March 2016
VA Hep C Treatment Guidelines
VA to treat all vets in system
 

By Judith Graham
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

 
Orange Count Registry
Vietnam vets blame 'jet guns' for their hepatitis C
By Lily Leung Feb. 14, 2016 
 
CBS News Investigates
Congress outraged over hepatitis C treatment VA can't afford
Dr. Raymond Schinazi played a leading role developing a drug that cures hepatitis C while working seven-eighths of his time for the VA
 
ibtimes.com| By amynordrum
 


Hepatitis C drug costing VA, DoD millions
By Patricia Kime, Staff writer
We're looking at a company who is milking a cash cow for everything it's worth," Sanders said. 
 


VA to outsource care for 180,000 vets with hepatitis C
Dennis Wagner, The Arizona Republic 12:27 a.m. EDT June 21, 2015
 


VA to outsource care for 180,000 vets with hepatitis C
, The Republic | azcentral.com 11:51 a.m. MST June 19, 2015
Dr. David Ross, the VA's director public-health pathogens programs, resigned from the working group. "I cannot in good conscience continue to work on a plan for rationing care to veterans," he wrote.
 


VA Region Stops Referring Patients To Outside Hospitals Thanks To Budget Shortfall
Michael Volpe Contributor ...According to a memo — the entire region has been forced to stop all “non-VA care” referrals due to a budget shortfall.
 

DisabledVeterans.org
OIG INVESTIGATES VA CHOICE PROGRAM PROBLEMS
Sen. Mark Kirk admitted the VA Choice Program is a failed joke in a letter to Secretary Bob McDonald despite attempts to fix it.
 

 
Denied Hep C VA dental care?
Please click here

 
Dried Hepatitis C Blood Exposure 11/23/2013 Weeks later inconspicuous blood transmits virus and more likely to cause accidental exposures to Hep C
 

Lack of Standards for
Mass Vaccinations
1970 Jetgun Nursing Instructions
 

2014 AASLD Study Hepatitis C not an STD

Home
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Documentation & Surveillance Alerts
Military Hepatitis History  
Understanding The Liver 
VA Flow Sheet for Cirrhosis
VA Defines Risk Factors
 
Hep C & Pro-Prebiotic
Need to know-Grassroots Research
 
Blog Another12Weeks
One Vets' Journey Though Treatment
 

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 What Would Veterans Do?
Blog for VA Claims
 


Help with VA Claims
 


 
Info: Plan Backfires-
VBA Fast Letter Boost Claims
 
Legal- Fed Regs state:
Judge decision may be relied upon
Cotant v. Principi, 17 Vet.App. 116, 134 (2003),
 
Service Connected Claims
# 1 Conclusion of Law 
# 2 Conclusion of Law 
 
More Claims
Jetgun Decisions
Hep C Decisions
 
Search Board of Appeals Website
BVA Jetgun Decisions
BVA Hepatitis C Decisions

Great Advice!  
After the jetgun win
What to do next

 

 
Hepatitis C (total 22 outbreaks, 239 outbreak-associated cases, >90,400 at-risk persons notified for screening):
  • 9 outbreaks occurred in outpatient facilities (including the above mentioned outbreak of both HBV and HCV), with 87 outbreak-associated cases of HCV and >91,100 persons notified for screening
  • 11 outbreaks occurred in hemodialysis settings, with 79 outbreak-associated cases of HCV and 1,833 persons notified for screening
  • Two outbreaks occurred because of drug diversion by HCV-infected health care providers, with at least 71 outbreak-associated cases of HCV and >19,000 persons notified for screening

Single identified cases are not included in the table and may be particularly difficult to confirm as healthcare-associated infection transmission events. However, although this list is not exhaustive, during 2008-2014 the following single cases were reported and confirmed as likely patient-to-patient healthcare-associated transmission:

http://www.cdc.gov/hepatitis/statistics/healthcareoutbreaktable.htm

Hepatitis C (HCV) Outbreaks by Setting
Setting Year State Persons Notified for Screening2 Outbreak-Associated Infections3 Known or suspected mode of transmission4 Comments
Outpatient
Hematology Oncology Clinic(20)
2012
MI
>300
10
Specific lapses in infection control not identified at the time of the investigation  
Pain management clinic (21)
2011
NY
466
2
Suspected syringe reuse contaminating medication vials  
Outpatient clinic (22)
2010
FL
3,929
5
Drug diversion (fentanyl) by an HCV-infected radiology technician  
Outpatient alternative medicine clinic (23)
2009
FL
163
9
Syringe reuse contaminating medication vials used for >1 patient
Use of single-dose vials for >1 patient
 
Endoscopy clinics (24)
2009
NY
3287
2
Suspected syringe reuse contaminating medication vials 2009 investigation of cases occurring in 2006- 2007
Ambulatory surgical centers (single-purpose endoscopy clinics) (n=2) (25, 26, 27)
2008
NV
>60,000
9
Syringe reuse contaminating single-use medications vials (propofol) that were used for >1 patient 8 cases were from the first center and one from the second.  The health department identified an additional 106 infections that could have been linked to the clinics. Note: this outbreak is also included in Thompson, et al, but at the time of publication only 6 cases had been identified.
 
Outpatient cardiology clinic (28)
2008
NC
1,200
5
Syringe reuse contaminating multi-dose vials of saline solution used for >1 patient An additional 2 new infections were identified in probable source patients
Totals
 
 
>69,345
 42
   
 


 

Long-term care
Skilled nursing (29)
2013
ND
>500
46
Epidemiologic analysis suggested podiatry care, phlebotomy, and nail care performed at the skilled nursing facility were associated with HCV infection  
 


 

Hospital
Hospital (30)
2012
NH
AZ
GA
KS
MD
MI
NY
PA
>11,000
45
Drug diversion by radiology technologist. Patients from 16 facilities in 8 states were notified about potential exposure and recommended to undergo testing for HCV infection.
Hospital-based surgery service (31)
2009
CO
>8,000
26
Drug diversion (fentanyl) by an HCV-infected surgical technician 18 cases were linked by viral sequencing to the surgical technician; an additional 8 infections were determined to be epidemiologically linked but viral sequencing was not able to be performed.  The number screened includes patients from three facilities where the surgical technician had worked.
Totals
 
 
>19,000
71
   
 


 

Hemodialysis
Outpatient hemodialysis facility (32)
2014
WA
186
3
Breaches in environmental cleaning and disinfection practices identified included: failure to consistently change gloves and perform hand hygiene between patients, and breaches in environmental cleaning and disinfection practices to prevent cross-contamination between clean and dirty areas  
Outpatient hemodialysis facility (33)
2014
TN
62
2
Breaches in environmental cleaning and disinfection practices  
Outpatient hemodialysis facility (34)
2014
NJ
69
4
Breaches in environmental cleaning and disinfection practices identified  included failure to: wash hands before and after glove use; adequately clean surrounding area of the station, the dialysis chair and priming bucket after use  
Outpatient hemodialysis facility (35)
2014
NJ
97
2
Breaches in environmental cleaning and disinfection practices identified  included failure to: appropriately separate clean and contaminated supply areas, properly disinfect clamps in the open position,  adequately clean the dialysis chair and priming bucket after use; ensure patients applying pressure to their own hemodialysis access site wash their hands after doffing gloves and prior to using the  scale.  
Outpatient hemodialysis facility (36)
2012
PA
66
18
Multiple lapses in infection control identified, including hand hygiene and glove use, vascular access care, medication preparation, cleaning and disinfection 18 new HCV infections between 2008–2013
Outpatient hemodialysis facility (37)
2012
CA
42
4
Specific lapses in infection control not identified at the time of the investigation  
Outpatient hemodialysis facility (38)
2011
GA
89
6
Failure to maintain separation between clean and contaminated workspaces   
Outpatient hemodialysis facility (39)
2010
TX
171
2
Specific lapses in infection control not identified at the time of the investigation  
Outpatient hemodialysis facility (40)
2009
MD
250
8
Breaches in medication preparation and administration practices
Breaches in environmental cleaning and disinfection practices
 
Hospital-based outpatient hemodialysis facility (41)
2009
NJ
144
21
Breaches in medication preparation and administration practices
Breaches in environmental cleaning and disinfection practices 
All patients who received dialysis in this facility since 2005 were notified for screening
Outpatient hemodialysis facility (42)
2008
NY
657
9
Failure to consistently change gloves and perform hand hygiene between patients. Breaches in environmental cleaning and disinfection practices All patients who received dialysis in this facility since 2004 were notified for screening
Totals
 
 
 1,833
79
   
 

 

1 Outbreaks with two or more outbreak-related infections detected are included.

2 The number of persons notified for screening is dependent upon information and resources available at the time of investigation and may underestimate the total number of individuals at risk.

3 Outbreak-associated HBV and HCV infections are defined as those with epidemiologic evidence supporting healthcare related transmission and include patients/residents identified with acute infection, or previously undiagnosed chronic infections with epidemiologic evidence indicating that these were likely outbreak-related incident cases that progressed from acute to chronic. Patients/residents identified as likely (previously infected) sources for transmission are not included. In the outbreak investigation setting case definitions are based on laboratory profile and clinical evidence rather than CDC surveillance case definitions which may omit asymptomatic cases.
Acute HBV is typically defined as having a positive hepatitis B surface antigen and positive IgM core antibody, or positive surface antigen and negative total core antibody (early infection). Chronic HBV is typically defined as having a positive hepatitis B surface antigen, positive total core antibody and negative IgM core antibody. There are no serologic markers to differentiate between acute and chronic HCV infection; defining an infection as possible healthcare transmission is dependent upon epidemiologic evidence along with a new finding of hepatitis C antibody and/or RNA positivity in a person not previously known positive (whether or not symptoms or alanine aminotransferase [ALT] elevation are present).

4 All modes of transmission are patient-to-patient unless otherwise indicated.

5 One additional healthcare facility outbreak was reported during 2009, in an Illinois psychiatric long term care facility with 8 outbreak-related hepatitis B cases among 180 residents screened, and an additional three cases of chronic HBV infection detected at the time of screening. The likely mode of transmission was sexual contact, though other behavioral risk factors such as illicit drug use could not be ruled out.
Source: Jasuja S, Thompson N, Peters P et al. Investigation of hepatitis B virus and human immunodeficiency virus transmission among severely mentally ill residents at a long term care facility. PLoS ONE 2012; 7: e43252. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043252