A scathing state report has found that a Jersey Shore medical clinic ignored standard hygiene practices, likely leading to 40 patients' developing septic arthritis of the knee after being treated there.

One physician at Osteo Relief Institute Jersey Shore, a clinic in Wall Township in Monmouth County, told Health Department investigators she did not wash her hands between treating patients. Nor was she in the habit of checking patients' vital signs before injecting their knees with a product that was supposed to relieve knee pain, the report stated.

Single-use vials of injectable contrast agent — which allows doctors to see where they are injecting their needles — were reused up to 50 times, potentially allowing the spread of germs from patient to patient. Leftover needles and syringes were thrown in the regular trash instead of containers approved for medical waste. Staff said they used hand sanitizer when preparing medications, but no sanitizer was found in the room, according to the report.

State and local health inspectors have identified 40 patients who came down with septic arthritis of the knee after undergoing treatment at the clinic, of which 29 required follow-up surgery to treat the infection, according to the March 24 state report, which was labeled preliminary.

Its authors said they could not determine which breach may have led to the infections, but said that in a number of respects, the clinic did not follow guidance from the U.S. Centers for Disease Control and Prevention.

"The infection practices at Osteo Relief Institute represent a deviation from guidelines provided by the CDC and endorsed by professional associations," the report stated.

Paul Werner, an attorney for the clinic, did not respond to a request for comment Tuesday.

Lawsuits against the clinic and staff were filed Monday on behalf of 17 patients in Superior Court in Monmouth County.

Joshua S. Kincannon, a Freehold lawyer who represents seven of the patients, said some of them required heavy-duty intravenous antibiotics to combat their infections. An additional 10 such patients are represented by another firm.  The lawsuits were initially reported by the Asbury Park Press.

Treatments at the clinic include injections with a fluid containing a substance called hyaluronic acid. Some studies have suggested it can help patients suffering knee pain, but in 2013, the American Academy of Orthopaedic Surgeons found there was insufficient evidence to support its use.

The clinic treated up to 85 patients a day in two exam rooms, according to the state report. Kincannon said such turnover suggests each visit lasted less than a quarter of an hour.

"I think that this clinic put profits above patient safety," Kincannon said. "I think that when you have a facility that is seeing 80-plus patients a day, it's not surprising at all that errors and safety breaches would occur."

Physicians wore gloves when administering the medication, but the gloves were not sterile, according to the report. Sterile gloves are not required but would be good practice, said Lawrence Muscarella, a biomedical engineer and infection-prevention consultant who reviewed the document.

"Any time a needle is penetrating the skin tissue and entering the vasculature, you don't want to introduce bacteria," said Muscarella, who is based in Montgomeryville.

In addition, sterile needles and syringes were unwrapped and placed in bins under a prep table for later use, state inspectors found. Guidelines call for waiting to unwrap needles until just before use, lest they become contaminated, Muscarella said.

For 15 of the infections, the bacteria from patients' knees was identified as species that typically live on the surfaces of teeth, the oral cavity, or the upper respiratory tract, according to the state report.

The clinic closed voluntarily March 7 and reopened two weeks later. The physician who said she did not wash her hands in between patients no longer works there, nor does a medical assistant who prepared medication, according to the state report.