The following Questions and Answers address what happened, how it happened, any potential risks, what can be done to ensure you and your children are safe, and how to reach us. Should you have any other questions or concerns, please do not hesitate to contact us at the number or email below.
[collapse title="Q. How did this happen?"]
A. Finger-stick blood samplers (lancet devices) are used to obtain blood for testing blood sugar (glucose). These devices consist of two parts: a “lancet holder” that looks like a small pen; and a lancet, which is the sharp point or needle that is placed in the holder. The lancets are only ever used once. Some types of “lancet holders” are designed to be used to test more than one person, while others are meant to be used to test only one person.
In some outpatient clinics at the Montreal Children’s Hospital, lancet holders that were meant to be used for only one person were used to test more than one person. Each lancet was never used more than once. Some hospital personnel using these lancet holders had misunderstood how the device was to be used and thought that the lancet was to be used only once, but that the holder could be re-used for other patients.
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[collapsed title="Q. How do I know if this type of lancet holder was used to test my child / me?"]
A. If this type of lancet holder may have been used to test your child / you, you will be receiving a letter in the mail informing you of this incident.
The lancet holders we are concerned about were used to check blood glucose (blood sugar) for some patients in the Diabetes and Dermatology Clinics only. We have surveyed all other locations and we have confirmed that these lancet holders were not used anywhere else. They were not used to do finger-sticks for any type of blood test other than blood glucose. For tests done in other areas there is no cause for concern.
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[collapsed title="Q. What does this mean for my child / me?"]
A. There has never been a report of any infection being passed from one person to another when this type of lancet holder is used in the way it was used in our clinics. Nevertheless, it is possible that a trace of someone else’s blood, too small to be seen, remained on the flat end of the cover of the lancet holder. If that happened when the lancet holder was used for your child / you, some of that blood may have gotten into your child’s / your blood through the finger-stick.
We do not think there is a risk of your child / you getting an infection from the use of this lancet holder, but because we cannot be absolutely sure, we want to advise you about this situation and, if you wish, offer you a blood test.
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[collapsed title="Q. Can I keep using the lancet holder that I have at home?"]
A. Yes. If you are checking your child’s / your blood glucose at home, it is safe to keep using the blood glucose monitoring kit that you have there. Remember that the kit you have at home is meant to be used to test a single person only, and so we advise you not to share your lancet holder or to test anyone else with it.
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[collapsed title="Q. What infection could my child / I have caught?"]
A. There has never been a report of any infection passed from one person to another when this type of lancet holder is used in the way it was used in our clinics. The holder was used a few times a week in the Diabetes and Dermatology Clinics only, and each patient was tested once or just a few times.
When this type of lancet holder was used to test patients living in nursing homes and in patients who were hospitalized for long periods of time not in the MUHC, some patients became infected with hepatitis virus, which causes infection of the liver.
The virus most commonly spread in the nursing homes was the Hepatitis B virus. The likelihood of having Hepatitis B virus is higher in elderly people in nursing homes than in young children. In Montreal, the rate of Hepatitis B infection in children is very low, and since 1994 all children in Quebec are offered vaccination against Hepatitis B when they are in Grade 4. Some children receive it earlier. This means that the chance of exposure to someone with Hepatitis B virus in our clinics is very low.
There is one report of the Hepatitis C virus spread by incorrect use of these lancet holders in patients who were admitted on a hospital ward. In that case, the holder was used many times a day on many patients. HCV infection is very uncommon in children in Canada.
HIV is another virus that can be found in the blood, but there has never been a report of HIV being spread by the use of lancet holders, even when they were used on hospital or chronic care wards where the same device was used many times a day on many patients. HIV has been transmitted by blood in other situations, for example, by blood transfusions, or by injuries from the type of hollow needle used to draw blood from a vein if there is visible fresh blood in the needle. HIV does not survive drying out, so we do not believe that the tiny trace of blood that may have been left on the lancet holder would be able to cause this infection. To be absolutely sure, we can offer testing for Hepatitis B and C, as well as HIV.
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[collapsed title="Q. Does the test have to be done?"]
A. The decision is up to you. We think it is very unlikely that your child or you have been exposed to any infection from the use of the lancet holder at the clinic, but if you wish, a blood test to check for Hepatitis B, Hepatitis C, and HIV can be done. The risk of infection is extremely low but we cannot be absolutely sure that there is none.
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[collapsed title="Q. How can I arrange for a blood test to be done?"]
A. If you choose to have the test done, it should be done at least 6 months after the last time the lancet holder was used in the clinic, as it takes that time for signs of infection to show up in the blood test. If you want the test to be done earlier, it can be, but it will need to be repeated later, at the appropriate time.
Your child / you can be tested at the next regularly scheduled clinic appointment at the Montreal Children’s Hospital (it is not risky to wait to have the test done).
If you do not have another clinic appointment at the Montreal Children’s Hospital, call 514-412-4400, extension 23522 between noon and 8 pm Monday to Friday, from July 11 to August 10, 2012 to arrange one.
If you prefer, you may take your child to another doctor or clinic for testing. If you choose to do that, we can arrange to have the test requisition sent to your doctor or clinic if you wish (call the number above).
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[collapsed title="Q. What is the hospital doing to make sure this does not happen again?"]
A. When the staff in the clinics became aware that the lancet holders were not to be used for more than one patient, they stopped re-using them immediately. Now, when a blood glucose test is done by finger-stick in a clinic, the staff uses a totally disposable device or a new testing kit that has never been used for another person.
A written procedure for finger-stick blood glucose testing has been prepared and all personnel involved will be instructed on which finger-stick blood sampling devices to use and how to use them safely.
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[collapsed title="Q. What are the symptoms of hepatitis?"]
A. Infection with hepatitis virus usually remains silent for many years before causing the infected person to feel sick. Some people with hepatitis clear the virus from their bodies, sometimes without ever becoming sick. Others may have serious liver disease later in life. A small number of people may become sick a few months after they are infected. Those who become sick may have nausea, vomiting, abdominal pain, and sometimes jaundice (yellow colour of the skin).
Treatment is available for chronic hepatitis, but it is not always successful.
Further information is available from Health Canada at:
http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/hepatitis/hep_b-eng.php
http://www.phac-aspc.gc.ca/hepc/pubs/getfacts-informezvous/index-eng.php
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[collapsed title="Q. What are the symptoms of HIV?"]
A. Like hepatitis, HIV infection often remains silent for years. If untreated the virus eventually begins to destroy the immune system and causes pneumonia, diarrhoea and other problems. Treatment keeps the virus under control.
Further information is available from Health Canada at:
http://www.phac-aspc.gc.ca/aids-sida/info/index-eng.php
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[collapsed title="Q. Where can I get more information about this situation?"]
- At your next clinic appointment, doctors will be available to answer your questions.
- If you have specific questions, you may send them to us by e-mail at: [email protected]
- You may call 514-412-4400, extension 23522 between noon and 8 pm Monday to Friday, from July 11 to August 10, 2012
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