Colorado Help Line: 1-877-462-2911

Unsafe Injections at an Oral Surgeon’s Offices: Frequently Asked Questions

What happened at Dr. Stein’s offices? Between September 1999 and June 2011, syringes and needles were re-used for multiple patients to give intravenous (IV) medications, including sedation. The IV medications were given during oral and facial surgery procedures. Needles and syringes were used repeatedly, often days at a time. Because there can be a small amount of blood that remains in syringes and needles after an injection through an IV line, there is a risk of spread of bloodborne viruses, such as HIV, hepatitis B, and hepatitis C, between patients. Due to the concern for the spread of HIV, hepatitis B, and hepatitis C, patients who received IV medications at Dr. Stein’s offices between September 1999 and June 2011 are advised to contact their health care provider to be tested for HIV, hepatitis B, and hepatitis C. Patients who can be identified through dental records are being notified by mail of their potential exposure. Other patients whose addresses were not known were notified through a news release. It is recommended that patients of Dr. Stein who received IV medications, including sedation, between September 1999 and June 2011 at one of two office locations contact their current health care provider to receive testing for HIV, hepatitis B, and hepatitis C. Where were Dr. Stein’s offices located? There were two office locations for Dr. Stein during September 1999 to June 2011: o Between September 1999 and June 2011: Stein Oral and Facial Surgery, 8671 South Quebec Street, #230, Highlands Ranch, CO 80130. o Between August 2010 and June 2011: Stein Oral and Facial Surgery, 3737 East 1st Avenue, Suite B, Denver, CO 80206. Patients were also seen at this location by Dr. Stein under the name New Image Dental Implant Center. How were patients exposed? Between September 1999 and June 2011, syringes and needles were re-used for multiple patients to give intravenous (IV) medications, including sedation. The IV medications were given during oral and facial surgery procedures. Needles and syringes were used repeatedly, often days at a time. Because there can be a small amount of blood that remains in syringes and needles after an injection through an IV line, there is a risk of spread of bloodborne viruses, such as HIV, hepatitis B, and hepatitis C, between patients. Due to the concern for the spread of HIV, hepatitis B, and hepatitis C, patients who received IV medications at Dr. Stein’s offices between September 1999 and June 2011 are advised to contact their health care provider to be tested for HIV, hepatitis B, and hepatitis C. What is an oral surgeon? An oral surgeon is a dental specialist who is trained to diagnose and treat injuries and diseases of the mouth, jaw, teeth, neck, gums and other soft tissues of the head. Oral surgeons completed four years of dental school and at least four years of a surgical hospital residency.

What is an intravenous (IV) line or IV medications? An intravenous or IV line is a tube that is inserted into a vein to give medications, including sedation, and fluids. What are “unsafe injection practices”? Unsafe injection practices are tasks that a health care provider performs using needles and syringes that might result in the spread of infections. Examples of unsafe injection practices include using a needle on more than one patient, even through an intravenous (IV) line; using a syringe on more than one patient even if the needle is changed; and entering a vial of medication after a needle or syringe is used on a patient. Unsafe injection practices put patients and health care providers at risk of infection. This harm can be prevented. Safe injection practices are part of precautions that every provider should follow (“Standard Precautions”). A safe injection does not harm the patient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous for the community. When giving an injection, a small amount of blood can backflow into the needle and syringe, even when injecting into an IV line. This blood is often not visible. If syringes are re-used on more than one patient, even if the needle is changed, patients can be exposed to the blood in the syringe and placed at risk of infection. In this case, the same syringe and needle was used to inject medications, including sedation, into multiple patients’ intravenous (IV) lines. This occurred while patients were undergoing oral and facial surgery procedures. For more information on unsafe injection practices:  http://www.cdphe.state.co.us/dc/Epidemiology/injsafety.html  http://www.cdc.gov/injectionsafety/  http://www.oneandonlycampaign.org/ Is syringe and needle reuse still ongoing at Stein Oral and Facial Surgery? No. Stein Oral and Facial Surgery is no longer an active practice. I was seen by Dr. Stein at another location OR during another time period. Am I at risk? At this time, we do not know if patients seen by Dr. Stein at other locations or before 1999 were at risk of acquiring bloodborne viruses. If you are concerned, we recommend you discuss this with your health care provider. I am a previous patient of Dr. Stein’s and I do not remember if I received intravenous (IV) medication. What should I do? If you are not sure if you received IV medications, including sedation, the safest option is to be tested for hepatitis B, hepatitis C, and HIV. You should talk to your health care provider about getting tested for hepatitis B, hepatitis C, and HIV. Anyone who received medications through an intravenous (IV) line during a procedure done by Dr. Stephen Stein at the following locations and during the following times should contact their health care provider to be tested for HIV, hepatitis B, and hepatitis C. o Between September 1999 and June 2011: Stein Oral and Facial Surgery, 8671 South Quebec Street, #230, Highlands Ranch, CO 80130.

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Between August 2010 and June 2011: Stein Oral and Facial Surgery, 3737 East 1st Avenue, Suite B, Denver, CO 80206. Patients were also seen at this location by Dr. Stein under the name New Image Dental Implant Center.

I am a previous patient of Dr. Stein’s and I did not receive intravenous (IV) medication. What should I do? Syringe and needle re-use was identified only for IV medication administration, including sedation. Patients who only received local injections (injections into the mouth) do not need to be tested. We do not recommend testing for patients who did not receive IV medications. However, if you are not sure if you received IV medications, the safest option is to be tested for hepatitis B, hepatitis C, and HIV. You should talk to your health care provider about getting tested for hepatitis B, hepatitis C, and HIV. Why should I be concerned about these infections if I haven’t had any symptoms? People infected with viruses like HIV, hepatitis B, and hepatitis C may not have symptoms for many years. It is possible you might have been infected and not know it. Even if you may not feel ill or remember getting sick, if you received IV medications, including sedation, at one of Dr. Stein’s offices between September 1999 and June 2011, you should be tested for HIV, hepatitis B, and hepatitis C to make sure you are not infected. Knowing whether you are infected is important, so you can be treated if your test results are positive. Do I need a letter from the state health department to get tested? No. You do not need a letter to get tested. If you were a patient who received medications through an intravenous (IV) line, including sedation, during a procedure done by Dr. Stephen Stein between September 1999 and June 2011 at the locations specified above, you should be tested for HIV, hepatitis B, and hepatitis C. How likely is it that I may be infected with HIV, hepatitis B, or hepatitis C from Dr. Stein’s offices? It is currently unknown if any transmission of hepatitis B, hepatitis C, or HIV, occurred as a result of unsafe injection practices at Dr. Stein’s offices. It is unknown how many, if any, people might have been infected at Dr. Stein’s offices. HIV, hepatitis B, and hepatitis C are routinely found in the population. Even if patients of Dr. Stein are infected, they may not have been infected at Dr. Stein’s offices. Although testing can determine if a person is infected, it cannot determine the source of the infection. In Colorado, the number of people living with HIV, hepatitis B, and hepatitis C in 2011 are estimated as follows: o In 2011, an estimated 1 out of 451 people in Colorado were reported to be living with HIV and AIDS. o In 2011, an estimated 1 out of 9840 people in Colorado were reported to be living with hepatitis B. o In 2011, an estimated 1 out of 1552 people in Colorado were reported to be living with hepatitis C. In Colorado, the Board of Health requires physicians and other health care providers to report HIV, hepatitis B and hepatitis C cases to the Colorado Department of Public Health and Environment.

To find out more about how these viruses are spread, please refer to the following resources: o HIV: http://www.cdphe.state.co.us/dc/HIVandSTD/index.html http://www.cdc.gov/hiv/default.htm o Hepatitis B: http://www.cdc.gov/hepatitis/index.htm http://www.hepatitiscolorado.info o Hepatitis C: http://www.cdc.gov/hepatitis/index.htm http://www.hepatitiscolorado.info What if my test is positive? If your test is positive, you will need to discuss this with your health care provider, who can determine the appropriate next steps. If it is determined that you have HIV, hepatitis B, or hepatitis C, it is important that you receive ongoing medical care and learn how to prevent transmission to others. If I am positive for HIV, hepatitis B, or hepatitis C, how will I know if I was infected from exposure at Dr. Stein’s offices? There is no way to know for certain if the infection was from a specific exposure. Testing cannot determine where you were infected. Have there been previous occurrences of HIV, hepatitis B, or hepatitis C transmitted in a health care setting? Recent investigations undertaken by state and local health departments and the Centers for Disease Control and Prevention (CDC) have identified improper use of syringes, needles, and medication vials during routine health care procedures, such as administering injections. These practices have resulted in one or more of the following: o Transmission of bloodborne viruses, including hepatitis C virus to patients o Notification of thousands of patients of possible exposure to bloodborne pathogens and recommendations that they be tested for HIV, hepatitis B, and hepatitis C o Referral of providers to licensing boards for disciplinary action o Malpractice suits filed by patients For more information on unsafe injection practices: o http://www.cdphe.state.co.us/dc/Epidemiology/injsafety.html o http://www.cdc.gov/injectionsafety/ o http://www.oneandonlycampaign.org/ As a patient, how can I protect myself? It is important to remember the possible spread of HIV, hepatitis B, and hepatitis C was not related to the dental procedures, but rather to unsafe injection practices during the administration of medications, including sedation, to patients. When proper injection practices are followed, medical and dental procedures, including oral surgery, are generally safe. All health care professionals and medical facilities should follow safe injection practices and infection control procedures. Patients can and should ask their medical providers about the practices used in their facility. As a patient, you should feel empowered to discuss with your health care provider what steps are being taken to protect you and your family. To learn more about injection safety efforts, please visit the following websites:

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http://www.cdphe.state.co.us/dc/Epidemiology/injsafety.html http://www.cdc.gov/injectionsafety/ http://www.oneandonlycampaign.org/

Health Care Providers: I am a health care provider, and my patient received IV medications from Dr. Stein between September 1999 and June 2011 at one of the specified locations. What tests should I order? All of the following tests should be ordered: o HIV antibody. If positive, reflex confirmatory testing with Western blot or other approved confirmatory methods should be performed. o Hepatitis C antibody. If positive, hepatitis C RNA (quantitative or qualitative) should be performed. (Reflex testing often is available for hepatitis C RNA.) o Hepatitis B surface antigen and hepatitis B core antibody should be done. Hepatitis B surface antibody also should be considered and is useful to determine immunity to hepatitis B. I am a health care provider and my patient received IV medications from Dr. Stein between September 1999 and June 2011 at one of the specified locations. Where should the blood sample be sent? Blood samples should be sent to the clinical laboratory you use for routine testing. I am a healthcare provider and my patient received IV medications from Dr. Stein between September 1999 and June 2011 at one of the specified locations. What should I do if a patient is found to have HIV, hepatitis B or hepatitis C? For hepatitis B or hepatitis C, you should consult with or consider referring your patient to a gastroenterologist. For HIV, you should consult with or consider referring your patient to an Infectious Disease/HIV specialist. Any positive result for HIV, hepatitis B, or hepatitis C is reportable to the Colorado Department of Public Health and Environment. Physicians are required to report positive results within 7 days of the positive result. To report a positive test, please call your local or state health department, or the Colorado Help Line at 1-877-462-2911, and specify this patient was tested as a result of unsafe injection practices at Stein Oral and Facial Surgery. I am a health care provider. How can I make sure this does not happen to my patients? Safe injection practices are part of precautions that every provider should follow (“Standard Precautions”). A safe injection does not harm the patient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous for the community. Health care providers should always follow safe injection practices: o Never administer medications from the same syringe to more than one patient, even if the needle is changed o Do not enter a vial with a used syringe or needle o Never use medications packaged as single-use vials for more than one patient. o Assign medications packaged as multi-use vials to a single patient whenever possible.

Do not use bags or bottles of intravenous solution as a common source of supply for more than one patient. o Maintain absolute adherence to proper infection control practices during the preparation and administration of injected medications. Become an advocate for safe injection practices. Provide education to your staff and other health care providers. Educate your patients on safe injection practices, and encourage your patients to ask questions regarding safe injection practices. For more information on unsafe injection practices: o http://www.cdphe.state.co.us/dc/Epidemiology/injsafety.html o http://www.cdc.gov/injectionsafety/ o http://www.oneandonlycampaign.org/ Resources: Where can I find out more information about injection safety? http://www.cdphe.state.co.us/dc/Epidemiology/injsafety.html http://www.cdc.gov/injectionsafety/ http://www.oneandonlycampaign.org/ Where can I find out more information about HIV? http://www.cdphe.state.co.us/dc/HIVandSTD/index.html http://www.cdphe.state.co.us/dc/HIVandSTD/fieldservfaq.html http://www.cdc.gov/hiv/default.htm Where can I find out more information about hepatitis B? http://www.hepatitiscolorado.info http://www.cdc.gov/hepatitis/index.htm Where can I find out more information about hepatitis C? http://www.hepatitiscolorado.info http://www.cdc.gov/hepatitis/index.htm

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