Amy E Warner1, Melissa K Schaefer2, Priti R Patel2, Jan Drobeniuc3, Guoliang Xia4, Yulin Lin4, Yury Khudyakov4, Candace W Vonderwahl5, Lisa Miller5, Nicola D Thompson6. 1. Division of Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO. Electronic address: Amy.warner@state.co.us. 2. Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 3. Assay Development and Diagnostic Reference Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA. 4. Molecular Epidemiology Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA. 5. Division of Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO. 6. Epidemiology and Surveillance Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
BACKGROUND: Drug diversion by health care personnel poses a risk for serious patient harm. Public health identified 2 patients diagnosed with acute hepatitis C virus (HCV) infection who shared a common link with a hospital. Further investigation implicated a drug-diverting, HCV-infected surgical technician who was subsequently employed at an ambulatory surgical center. METHODS: Patients at the 2 facilities were offered testing for HCV infection if they were potentially exposed. Serum from the surgical technician and patients testing positive for HCV but without evidence of infection before their surgical procedure was further tested to determine HCV genotype and quasi-species sequences. Parenteral medication handling practices at the 2 facilities were evaluated. RESULTS: The 2 facilities notified 5970 patients of their possible exposure to HCV, 88% of whom were tested and had results reported to the state public health departments. Eighteen patients had HCV highly related to the surgical technician's virus. The surgical technician gained unauthorized access to fentanyl owing to limitations in procedures for securing controlled substances. CONCLUSIONS: Public health surveillance identified an outbreak of HCV infection due to an infected health care provider engaged in diversion of injectable narcotics. The investigation highlights the value of public health surveillance in identifying HCV outbreaks and uncovering a method of drug diversion and its impacts on patients.
BACKGROUND: Drug diversion by health care personnel poses a risk for serious patient harm. Public health identified 2 patients diagnosed with acute hepatitis C virus (HCV) infection who shared a common link with a hospital. Further investigation implicated a drug-diverting, HCV-infected surgical technician who was subsequently employed at an ambulatory surgical center. METHODS:Patients at the 2 facilities were offered testing for HCV infection if they were potentially exposed. Serum from the surgical technician and patients testing positive for HCV but without evidence of infection before their surgical procedure was further tested to determine HCV genotype and quasi-species sequences. Parenteral medication handling practices at the 2 facilities were evaluated. RESULTS: The 2 facilities notified 5970 patients of their possible exposure to HCV, 88% of whom were tested and had results reported to the state public health departments. Eighteen patients had HCV highly related to the surgical technician's virus. The surgical technician gained unauthorized access to fentanyl owing to limitations in procedures for securing controlled substances. CONCLUSIONS: Public health surveillance identified an outbreak of HCV infection due to an infected health care provider engaged in diversion of injectable narcotics. The investigation highlights the value of public health surveillance in identifying HCV outbreaks and uncovering a method of drug diversion and its impacts on patients.
Authors: Walter C Hellinger; Laura P Bacalis; Robyn S Kay; Nicola D Thompson; Guo-Liang Xia; Yulin Lin; Yury E Khudyakov; Joseph F Perz Journal: Ann Intern Med Date: 2012-04-03 Impact factor: 25.391
Authors: P Simmonds; E C Holmes; T A Cha; S W Chan; F McOmish; B Irvine; E Beall; P L Yap; J Kolberg; M S Urdea Journal: J Gen Virol Date: 1993-11 Impact factor: 3.891