Public Health History: “But it’s just a little needle…”: Looking to our past for lessons in infection prevention and control
Public Health History
26 Oct 2016
Diseases spread through blood such as HIV/AIDS and hepatitis B were front and centre for public health in the 1980’s and 90’s, especially in the realm of infection prevention and control. Our experiences led to sweeping changes in practices by health-care workers today. Dr. Ian Johnson, Public Health Physician at PHO, knows this first hand.
In 1996, an outbreak of hepatitis B erupted and was linked to a neurology clinic in Toronto. The infections stemmed from the contamination of small needles used during electroencephalograms (or EEGs), a common test used to measure electrical activity in the brain. Dr. Johnson, then a local Associate Medical Officer of Health, was leading the investigation.
This was a complex investigation that involved trying to trace and test almost 20,000 patients who may have been exposed. This was all while trying to coordinate with regulators for medical practice, navigating the legal ramifications of a large class action lawsuit against the clinic, and responding to constant media and public attention.
Though infection prevention and control practices were well understood in the 1990s, practice among clinicians varied. The small needles used to attach EEG electrodes to the skin are now banned in Ontario. “It woke people up,” says Dr. Johnson “people didn’t realize how infectious hepatitis could really be, and that a very small needle could be responsible for infection. Our work contributed to a lot of changes in infection prevention and control in Ontario”.
Looking back, Dr. Johnson describes the emergence of HIV/AIDS as a big turning point for infection control practice. “There was a total 180 degree change by clinicians in the 1980s”. Recalling his time as a medical student in Halifax in the 1970s, it was routine for clinicians to draw blood from patients without gloves and without a place to safely dispose of used needles. “This was pre-AIDS, and pre-hepatitis, before we knew about precautions for blood-borne diseases. There was a knowledge gap, people didn’t know the risk existed. Getting accidentally pricked by a needle was just part of the job”.
Public health was central in the adaptation of routine infection prevention practices for healthcare workers, including the use of gloves and sharps disposal for needles. After AIDs, doctors scrambled to figure out how to treat HIV-positive patients differently. “But for public health, we were saying apply universal precautions; treat every patient with the same measures”.
Though we can look back on our successes over the past several years, we must remain vigilant in preventing outbreaks in health-care settings. The goal remains the same to Dr. Johnson: “It’s all about how we can best protect the public from harm”.