Covenant Health

Covenant Health notifying patients of potential risk of exposure to Hepatitis B and C

Frequently asked questions


Click here to download the Frequently Asked Questions (PDF)

What is this patient notification about?

Covenant Health has mailed letters to 1,307 patients who may have been exposed to Hepatitis B and C through an infection control breach that happened during individual insulin training sessions at the Grey Nuns and Misericordia Community Hospitals Diabetes Education Centres, between 2013 and early 2016.

The risk to the people being notified is considered very low. However, as a precaution, all affected patients are being advised to be tested for both the Hepatitis B and C viruses.

This risk is not ongoing, and only those individuals who receive notification letters from Covenant Health are considered exposed.

The infection control breach was associated with the use of saline-filled demonstration pens and the pillows used for practice with these pens. Though the needle in the demonstration pens was changed with each use and needles were never shared between patients, the pen's saline reservoir was not routinely changed with every patient. Additionally, the practice pillows may have been used by multiple patients using their own pens.

This incorrect training practice was discontinued immediately upon being identified in February 2016. Alberta Health Services was asked to conduct a review through their Risk Assessment Panel. Upon being advised by this expert panel that disclosure to patients was warranted, Covenant completed the look-back process to get to this step of notification.

The notification applies to patients with diabetes or gestational diabetes who received insulin pen training at:

  • Grey Nuns Community Hospital Diabetes Education Centre between March 2013 and February 19, 2016; or
  • Misericordia Community Hospital Diabetes Education Centre between May 2014 and February 19, 2016.

These patients will receive a letter from Covenant Health and are encouraged to go for a blood test. 

Time frame:  

Site

Start date

End date

Number of patients

GNCH DEC

March 2013

February 19, 2016

952

MCH DEC

May 2014

February 19, 2016

355

Who should be tested?

People with diabetes or gestational diabetes who started on insulin at:

  • The GNCH DEC between March 2013 and February 19, 2016, or
  • The MCH DEC between May 2014 and February 19, 2016.

This only applies to people who attended the day clinics as outpatients. No inpatients were affected.

Potentially affected patients will receive a letter from Covenant Health in the mail.

Where did this happen?

This happened at two sites in Edmonton:

  • The Grey Nuns Community Hospital Diabetes Education Centre (GNCH DEC) between March 2013 and February 19, 2016
  • The Misericordia Community Hospital Diabetes Education Centre (MCH DEC) between May 2014 and February 19, 2016

This notification only applies to people who attended day clinics as outpatients. It does not apply to inpatients.

How will patients know if they have been exposed?

If a patient has been exposed, they will receive a letter from Covenant Health. The letters were put in the mail on June 28, 2017. It is expected that all letters will be delivered within two to three weeks.

How/when will patients be contacted?

Covenant Health mailed letters to patients on June 28, 2017. Please allow two to three weeks for delivery. 

What if the patient has moved?

Covenant Health will attempt to phone patients whose letters are returned undeliverable.

Covenant Health has posted information about the patient notification on its website: CovenantHealth.ca

Covenant Health has shared the information with the media.

When will patients receive their notification?

Covenant Health mailed letters to patients on June 28, 2017. Please allow two to three weeks for delivery. 

What can patients do if they don’t have a physician?

Patients can take the letter they get from Covenant Health to any walk-in or family practice clinic in Alberta. The doctor there should give them a form for the blood test and follow up with any concerns. 

What can patients do if they think they may have been exposed, but have not received a letter?

Covenant Health mailed letters to patients on June 28, 2017. Please allow two to three weeks for delivery.

If you have not received a letter after three weeks and you think you should have received one, please contact Health Link at 811. 

What are Hepatitis B and C?

Hepatitis B and C are viruses that can affect the liver. Many people who become infected with Hepatitis never feel sick, while others may experience nausea or flu-like symptoms. Hepatitis B and C can be treated through anti-viral medication.

For more information on Hepatitis please visit myhealth.alberta.ca or your health care provider.

What does testing involve?

It is a blood test. No special preparation is necessary before the test.  You will first need to get a requisition form from a doctor before you can have the test done. Please remember to bring the form with you when you go for your blood test. You cannot have the test done without the form.

Will I need repeat testing?

Most people will only require one blood test. If you require further follow-up testing, you will be contacted by phone to discuss your results and the recommended next steps.

Should I be tested for human immunodeficiency virus (HIV)?

No. HIV testing is not recommended in this circumstance. An expert panel has advised it is not required.

If you would like to be tested for HIV, you can have a discussion and potentially access testing through a community physician of your choice.

I was pregnant at the time of my insulin pen training. Do my children need testing?

No. Your children do not need testing at this time. The risk of infection from this exposure is very low. The results of your test will be used to determine if anyone else needs to be tested.

How will people know their test results?

Please follow up with the physician who provided the lab requisition three to four weeks after your blood test. Public Health will directly contact any individual with a positive test.

What will happen if the test is negative?

No further contact or actions will be required.

What will happen if the test is positive?

The physician who ordered the test should follow up with you regarding your results to ensure that you receive the appropriate medical care and follow up.

A copy of the positive test results will also be sent to Public Health. A public health nurse will contact patients to discuss their test results and complete the required Public Health follow up.

Is it possible that a person could have already been infected with Hepatitis B or C before this?

Yes. Someone may have been previously exposed and infected without knowing it in a way not related to this event.

Who do I call for results?

Please follow up with the physician who provided the lab requisition three to four weeks after your blood test. Unfortunately we are not able to provide test results.

When was this discovered?

Leadership at Covenant Health became aware of the incorrect practice on February 19, 2016 and immediately stopped the practice. The practice had been happening at both the GNCH and MCH Diabetes Education Centres.

Part of the work of the Diabetes Education Centres is to help people with diabetes understand how to take insulin through an insulin pen. This teaching is done one-on-one, not in an observer classroom or public setting.

The practice was stopped as soon as it was discovered. Covenant Health asked Alberta Health Services to conduct a thorough investigation through their Risk Assessment Panel.

A number of steps have been taken to ensure the demonstration devices are being used correctly across Alberta, including:

  • New guidelines for demonstration devices have been developed and implemented at all Diabetes Education Centres in Alberta.
  • Staff have received upgraded orientation and education regarding saline-filled demonstration pen use.
  • Staff will now complete annual one-on-one training with a Clinical Nurse Educator to ensure best practice

How was the practice discovered?

Leadership at the Diabetes Education Centre was discussing the impact of a practice change with staff and asked for a description of the current process. As soon as the leader became aware of the incorrect practice, it was immediately stopped.

If the practice was stopped in February 2016, why is Covenant Health notifying patients now?

The risk assessment process is complex, and takes time to ensure that all potentially impacted patients are identified and correct actions are taken. Covenant Health and Alberta Health Services both conducted thorough investigations and reviews. These required input and analysis from different experts. The experts took the time necessary to be thorough. Covenant Health is committed to ensuring the information shared is complete and accurate. 

How do I know this didn’t happen in other clinics?

The practice was stopped as soon as it was discovered. Education and new guidelines were then provided to diabetes clinics across the province. Completion of education was confirmed by survey.  

What is being done so this doesn't happen again or somewhere else?

Covenant Health and Alberta Health Services have taken a number of steps to ensure the saline-filled demonstration pens are being used correctly across Alberta.

The incorrect practice was stopped as soon as it was discovered. Covenant Health and Alberta Health Services acted swiftly, conducting thorough investigations.

Covenant Health and Alberta Health Services have provided education and new guidelines to diabetes clinics across the province.

The potentially contaminated saline-filled demonstration pens were immediately removed from both the MCH and GNCH Diabetes Education Centre.

Covenant Health brought in new written guidelines for insulin teaching on March 3, 2016. Orientation and practice materials have been revised and updated.

AHS provided staff with education about the use of demonstration insulin pens. Staff were required to fill out a survey to show they had completed the education.