Infection reporting on the rise in valley

By Marshall Allen

Saturday, Jan. 24, 2009 | 2 a.m.

The number of suspected infections reported by Southern Nevada health care providers has increased significantly in recent months, probably because they are more vigilant after last year’s hepatitis C crisis, the state’s medical epidemiologist says.

Case in point: A reported cluster of 16 possible infections related to breast expander surgeries in Las Vegas has triggered a multiagency probe that’s being led by the Southern Nevada Health District, the organization that investigated the hepatitis C outbreak.

Breast expander procedures generally follow a mastectomy, serving to expand breast tissue over time in order to insert an implant. An expander can be likened to a balloon, and after insertion it is filled with incremental additions of fluid to expand the space where the implant will rest.

It’s rare to observe a cluster of possible breast expander infections, said Dr. Ihsan Azzam, the state medical epidemiologist, who works for the Nevada State Health Division. Azzam said the investigation is in its early weeks, so it’s unclear whether there is an actual outbreak or a false positive — as is the case with many reports of observed infections.

What is clear is that health providers are attuned to the potential that diseases are being spread in Las Vegas health facilities, which Azzam says is a good thing.

“This is a clear example that new partners are coming aboard,” Azzam said of the more responsive medical community. “People are more aware and conscious. People are reporting everything. Since the outbreak of hepatitis C, we have a significantly larger number of reports from doctors, nurses, physician assistants ... That really helps me.”

There are so many variables that it could take weeks to understand the cause of the possible breast expander infections, which have been observed at multiple hospitals, sources said. University Medical Center is one of the locations.

UMC officials said the potential problem was identified by an admitting technician who had a gut feeling there were an unusually high number of women coming to the hospital with breast-related infections. The technician turned over a list of 15 patient names to the hospital’s infection control department, which began an internal investigation to determine any common links.

Dr. Alan Greenberg, medical director of UMC’s infectious disease department, said he typically sees two or three of the same type of infections in a given year, and that not all 15 initial UMC cases involved breast expander procedures. The UMC investigation, which is ongoing, has confirmed three cases of breast expander infections and one related to a breast augmentation procedure. One of the infections came after the patient suffered trauma at the site, he said.

Greenberg said there are no known links between the procedures at this time, “but because everyone is on heightened alert and there’s a more frequent admission rate for this diagnosis than in the past, we noticed.”

Greenberg said he has contacted surgical groups in Las Vegas that perform the procedures and they have been cooperative — checking to see whether they’ve changed any techniques or implant materials. He said the emphasis on infection prevention is standard in hospitals, which is different from the outpatient clinic that caused the hepatitis C outbreak, which has no such structures in place.

A review of medical literature shows that infections can be a complication in a small percentage of breast expander procedures. The initial challenge, Azzam said, is to confirm that the women involved have actual infections and not some other problem, such as dead tissue. Then it will be a matter of going step-by-step through the process of each procedure to determine any common factors that could have caused an infection. Because there are many variables — the type of device, facility where the operation took place, staff involved, location of follow-up appointments and more — determining the source of the infection is a challenge, Azzam said.

A source familiar with the investigation said a single surgeon may be a common link among patients who suffered complications. The surgeon did not return the Sun’s phone calls. Other doctors told the Sun that the same surgeon performing the procedures shouldn’t suggest he is to blame.

UMC officials said each patient had multiple doctors, so it’s too early to say whether one was in common.

Officials from the Southern Nevada Health District confirmed they are investigating the infections, but would not comment on the situation.

“It’s so fluid we don’t really know what it is,” a Health District official said. “It’s really preliminary.”

The Centers for Disease Control and Prevention is assisting in the investigation.