A hospital in New Hampshire whose patients may have been exposed to hepatitis C has revised processes for securing syringes in its cardiac cath lab after an investigation by the Centers for Medicare & Medicaid Services and the state’s Department of Health and Human Services (HHS) found the facility failed to meet standards. The HHS reported Aug. 9 that an additional patient who received care in the cath lab tested positive for hepatitis C, bringing the total to at least 31.

Exeter Hospital in Exeter, N.H., is continuing to offer free confidential tests to patients who were treated at the hospital between April 1, 2011 and May 12, 2012, the period when a technician who carries the virus was employed. Tests have shown that the strain of hepatitis C found in David Kwiatkowski is the same as that found in the patients. He is being held in county jail on federal charges of stealing drugs and tampering with consumer products, according to the New York Times.

At least 250 patients have been tested so far. Testing will continue through Aug. 18.

In the filing of deficiencies, CMS and the HHS claimed that cath lab personnel left syringes with controlled medications on a medication cart while they put on lead aprons.

“Staff D [nursing] was asked during that time if the medications that were drawn up were in their possession or left on top of the Pyxis machine (medication cart),” according to the statement of deficiencies. “Staff D confirmed that the medications were left on the Pyxis machine when putting on the lead apron. Staff D stated that other co-workers are in the procedure area during this time including the cardiac cath technicians (who do not have the authority to handle medications). Staff D did state after the interview, ‘probably not the best practice.’”

Exeter Hospital has upgraded its procedure for securely storing controlled substances by placing syringes with medications in a drawer that is closed. Nurses then must log into the Pyxis and select a “remove medication functionality” and “cath lab syringe storage” to open the drawer and remove the medication. Used syringes are placed back in the drawer, which is then closed.

The HHS announced on May 31 that four of the hospital’s patients had been diagnosed with hepatitis C and that the cath lab voluntarily suspended operations on May 25. The investigation has since expanded across the country, based on Kwiatkowski’s employment history. He worked in hospitals in Arizona, Georgia, Kansas, Maryland, New York and Pennsylvania, as well as New Hampshire, over the past 10 years, according to the New York Times.