As reported by philly.com, New Jersey Department of Health investigators have released a preliminary report finding that that the Osteo Relief Institute Jersey Shore in Wall Township deviated from multiple infection control guidelines issued by the Centers for Disease Prevention and Control.

The report indicates that the clinic’s disregard of accepted hygiene practices likely caused 40 patients to develop septic arthritis of the knee following injections to treat knee pain. The clinic was closed in March but reopened two weeks later. The clinic treated up to 85 patients a day at the time of the infection outbreak, according to the report.

One physician at the clinic told health department investigators she did not wash her hands between procedures. Most troubling was the report’s finding that single-use vials were reused on multiple patients and leftover needles were put in the trash instead of in approved medical waste containers.

Lawsuits have been filed on behalf of several of the affected patients.