Upwards of 2,700 patients, including children, need to be tested for HIV and hepatitis because a handful of nurses in a northern Alberta hospital injected drugs with dirty syringes for nearly two decades. Blood tests are being arranged for 1,300 patients who had endoscopy procedures at the High Prairie Health Complex over four years dating back to March, 2004. Officials said last week that fewer than five nurses were routinely injecting painkillers into intravenous lines with syringes that had already been used in lines attached to other patients. As many as 1,400 patients who had dental surgeries at the same hospital dating back to 1990 also need to be tested, said Albert de Villiers, the region’s medical health officer. Alberta Minister of Health and Wellness Ron Liepert discussed the issue at a news conference at the Alberta Legislature in Edmonton on Oct. 27. “We are assuming at this point that a large number of them will be children because it’s more children that get dental surgery,” he told a news conference Monday. He said no infections have been found and the risk is very low, but “it is not an acceptable practice that we have identified and that’s why we stopped the practice.” The problem in High Prairie was discovered earlier this month by a manager who observed a nurse using a dirty syringe. It took three weeks to sort out which patients may have been infected and whether blood testing was required, Dr. de Villiers said. Patients will be contacted by phone and registered mail for testing, which will be co-ordinated by Alberta Health. “It might be tricky to track down all the patients,” Dr. de Villiers said. “We will try our best.” The injections were performed by both registered nurses and licensed practical nurses, who both receive training on safe injection practices, said a spokesman for the health region. Robin Laughlin, a physician who does most of the endoscopies in the town and has worked in the region for 35 years, said he was surprised and disappointment by the news. Dr. Laughlin said he doesn’t know why the syringes were reused or what happened to quality control. “That’s obviously one of the questions that has to be answered.” In endoscopy, a fibreglass scope is inserted into a patient’s bowel or stomach and beams back video images to scan for cancers, colitis and digestive problems. Prior to the procedure, the patient is sedated by a syringe inserted into the intravenous line. Intravenous lines sometimes have blood seeping into them from a vein and a syringe could come in contact with the blood and possibly spread an infection. Alberta’s Quality Health Council is investigating, but hospital staff are reportedly reluctant to answer questions. “We’re talking about a group of staff isolated in one department in the facility,” said Tim Guest, a vice-president for the local health region. “It’s not widespread in the entire facility. It’s] a very small number of employees — less than five.” Health Minister Ron Liepert said he suspects human error is the root cause, but said the investigation will not focus on laying blame. “We have a health system that is made up of hundreds of thousands of people. They’re all human beings. There will be mistakes that will be made,” says Liepert. “As soon as we start pointing fingers or wanting to lay blame, people are not going to want to co-operate.” Liepert took heat in the legislature Monday from Pearl Calahasen, a former cabinet minister who lives in the area. She wondered if her family and friends will lose faith in patient safety. “Can they still trust the health-care system even when these kinds of things continuously happen?” she demanded of Liepert. “How long will it take to track all these patients down to test them so they can be sure they’re not infected?” Heather Smith, president of the Alberta Union of Nurses, says she’s anxious to learn specific details about what was being done, why it was being done and for how long. “Who was involved in establishing that protocol or that practice?” asked Ms. Smith, whose union represents 24,000 registered nurses. “Was this being driven in any part by a need to minimize costs by reusing the syringes?” The Alberta Union of Provincial Employees cautioned that unsound practices should not be blamed on front-line workers. “While we do not know how the government is going to respond to the situation in High Prairie ... we do not think it would be in any way appropriate for blame in this case to be assigned to working people who are doing their best in very difficult circumstances,” union president Doug Knight says in a release. Knight said health-care employees have been “raising warning flags” for years about under-staffing, overwork and cost-cutting policies that pose a risk to patients and hospital staff. High Prairie, located on the west end of Lesser Slave Lake, has a population of 3,000 but administers to 17,000 in its service area. It is a regional centre serving a mixed farming, forestry and oil and gas community. This is the second case involving poor sterilization procedures at an Alberta hospital in recent years. In early 2007, poor sterilization techniques and the outbreak of a superbug forced 3,000 patients from St. Joseph’s Hospital in Vegreville east of Edmonton to be tested for infection. The 25-bed hospital was closed for several weeks after instruments were recirculated with flecks of blood and dead tissue on them. A class-action lawsuit has since been filed, claiming the hospital failed to ensure the instruments were properly cleaned.