"A much wider scope for both was necessary to establish a true root cause," the agency wrote.
According to the plan it submitted to the government, the hospital later implemented a long list of changes, including new risk reduction strategies and employee education programs. It also conducted a thorough evaluation of the equipment, personnel and environmental factors that could have contributed to the outbreak, created a drug diversion team and changed its hiring practices to better weed out potential problem employees.
The federal inspections were trigged by the case of David Kwiatkowski, a former hospital worker accused of stealing drugs from the hospital's cardiac catheterization lab and replacing them with tainted syringes that were later used on patients, 32 of whom have been diagnosed with the same strain of hepatitis C virus he carries. He pleaded not guilty in federal court last week to 14 counts of tampering with a consumer product and illegally obtaining drugs.
Before working at Exeter, Kwiatkowski worked as a traveling technologist in 18 hospitals in seven states, moving from job to job despite having been fired twice over allegations of drug use and theft.
Thousands of patients have since been tested for hepatitis C, a blood-borne viral infection that can cause liver disease and chronic health issues. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Kwiatkowski carries.
An agency report in July also said nurses at the Exeter cardiac lab left syringes unattended after removing medication from machines. The hospital has since implemented a policy that requires filled syringes to be placed in a locked drawer until needed.
The latest report, which included details of a September inspection, found that a variety of medications were left in an unlocked refrigerator in one of the lab's procedure room. The hospital has since locked the refrigerators and begun weekly reviews of all medication storage areas.
The hospital has also corrected another security issue pointed out by federal inspectors. In the past, ambulance workers were given remote access key fobs to access the hospital during off hours, but that practice was stopped after hospital staff were unable to identify who had the devices or even how many were in circulation. The hospital also tightened its policy on access to the emergency department after inspectors found that the department director did not know who had access to the department.