A hospital in Indiana says it may have exposed as many as 1,182 of its patients to a variety of serious diseases including HIV, hepatitis C, and hepatitis B. The announcement comes as the hospital admits that it was failing to sanitize its instruments in the correct manner, skipping a step that is intended to ensure total sterilization and disinfection.

The bulletin by Goshen Hospital notes that those who were potentially impacted by the error can come in for free testing to detect whether or not they now have any of the three serious infections. The hospital considers the risk of an infection to be low, as the instruments used were still sterilized to a certain degree, but the potential remains that one or more of the viruses jumped from one patient to the next via unsterile instruments.

The bulletin issued by Goshen Health reads:

Goshen Health recently became aware of a situation that may have impacted surgical patients at Goshen Hospital from April through September 2019. During this time, one step in a multistep cleaning process was not completed with certain surgical instruments in a limited number of cases. The surgical instruments in question were still treated with other usual chemical disinfection and machine sterilization processes which include a wide margin of safety; however, we are not able to determine if such instruments were completely sterile prior to use. This action has the potential of exposing a limited number of patients to the hepatitis C virus, hepatitis B virus and human immunodeficiency virus (HIV). Even though we believe the risk to be extremely low, out of an abundance of caution, we are offering patients free testing for these viruses.

The hospital doesn’t explain how the important sterilization step was skipped, though it does note that once the error was discovered it was “immediately corrected.” It says it has since put additional safety measures in place to ensure the unfortunate incident isn’t repeated.

The hospital has also set up a call center to field questions from patients who think they may have been affected by the error. Surgery patients who visited the hospital between April and September 2019 can call in and schedule a free test.

“While we apologize for the worry and inconvenience this situation may cause, our patients’ safety and well-being are our utmost priority,” Randal Christophel, President and CEO of Goshen Health, said in a statement. “We want to assure our patients we will assist in every way possible. For those patients receiving a letter, please call us at (574) 364-2100 with any questions and take the time to get tested.”