SALT LAKE CITY — At least 16 people were infected with hepatitis C in an outbreak associated with a former health care worker who was employed at hospitals in Layton and Ogden, a Utah Department of Health investigation found.
Public health officials began investigating the outbreak last fall after discovering that a patient and nurse at McKay-Dee Hospital tested positive for the same rare strain of the virus.
The nurse in question, identified by Ogden police as Elet Neilson, also known as Elet Hamblin, 49, of Layton, was fired from McKay-Dee in 2014 after being confronted with evidence she had stolen opioid painkillers from the hospital, according to hospital spokesman Chris Dallin.`
Officials would not speculate on how the virus was transmitted. But Angela Dunn, an epidemiologist with the Centers for Disease Control and Prevention stationed at the Utah Department of Health, said “in the U.S., the most common way of transmitting hepatitis C is through needles, and the only way to transmit hepatitis C is blood to blood.”
Some patients are working with lawyers to bring the case to court.
Douglas Olcott, an attorney in Pennsylvania, said he is in touch with more than 140 patients, six of whom have tested positive for hepatitis C.
Some of their patients have unrelated health problems, now complicated by hepatitis C, he said. Another client is a mother who became pregnant after getting infected.
“We’ve talked to people who are like, ‘My 10-year-old kid likes to come in and sees me shaving, (and) they want to pick up the razor,’” Olcott said. “They are small-risk things, but when it’s your kid and your worry, it’s the biggest concern in the world.”
Drug diversion in hospital settings is becoming a growing problem, according to several experts.
Scott Byington, president of the Utah chapter of the National Association of Drug Diversion Investigators, said health care workers can become skilled at finding weak links in the system, often taking advantage of times when the facility is busy or understaffed to steal leftover medication that should have been thrown away.
Sometimes, as in the case of a Denver hospital technician who infected at least 18 patients with hepatitis C in 2009, health care workers are found putting injection equipment back into circulation to avoid detection.
“When they start diverting medication like that, especially in the health care arena, they become very, very good at it and covering it up,” Byington said. “The employee may be so good at it that they don’t get caught, even with all the safeguards in place.”
About 3,700 patients at McKay-Dee Hospital and Davis Hospital and Medical Center were tested out of an estimated 7,200 who may have been exposed, according to the health department.
Before Neilson was hired at McKay-Dee, she was working in the emergency department at Davis Hospital, where the health department said she was engaging in “similar behavior.”
Neilson was reprimanded and fined $100 for stealing IV Benadryl from her employer around that time, according to licensing documents and health officials.
Of the 16 people who tested positive for hepatitis C, one was the health care worker herself, according to the report. Another was a patient at Davis Hospital; the rest were patients at McKay-Dee.
Dallin declined to talk about whether McKay-Dee knew about Neilson's history when they hired her but said all applicants need to have a positive recommendation from a previous employer to be eligible.
He said the hospital counts on other health care facilities and the state licensing division “to give us the information that we need in order to make a decision.”
Diane Townsend, the spokeswoman for Davis Hospital, declined to answer questions about the hospital's involvement in the outbreak.
Dallin said McKay-Dee is still offering free hepatitis C testing “for the foreseeable future," and he encouraged those who have not yet been tested to do so.
The hospitals are working with infected patients on a case-by-case basis to determine how to pay for their treatment, he said.
According to Dunn, attention will now turn to compiling “lessons learned” from the outbreak.
“This is something we and the Utah Department of Public Health are becoming more aware of,” she said. “We don’t know if it’s been happening and we just haven’t been aware of it, but it’s definitely something we’re becoming more aware of.”
Dunn said the health department observed the hospitals’ infection control practices and “didn’t see anything that was overwhelmingly at risk for the spread of bloodborne pathogens.”
Dunn said she wants to improve collaboration between health care facilities and the state licensing division.
The health department knew about the initial infected patient as early as November 2014 but closed the investigation without looking into the possibility that he had been infected at a hospital, she said.
The health department also knew about three other patients who were previously diagnosed with the same rare strain of hepatitis C, but couldn’t figure out if they were infected recently or not, according to Dunn.
It wasn’t until the CDC asked local officials to look into the possibility of a health care-associated infection that officials reopened the case, Dunn said.
“That’s not a typical part of our investigation. Not yet," she said. "It is becoming more of a national issue, so I assume things are going to change.”