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PREVENTION IN ACTION
Stolen syringes:
How does a patient go into
a hospital and come out
with hepatitis C?
A message from CDC
BY JOSEPH PERZ, DrPH, MA
W
hen prescription medicines are obtained or used illegally, it is called drug diversion. One example
of this occurs when healthcare providers steal patients’ medications for their personal use. This
is a serious threat to patient safety. For example, when providers tamper with injectable drugs
and use unsafe injection practices, patients can become infected with bloodborne pathogens such as hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), or develop a bacterial infection.
At CDC, we have assisted in the investigation of numerous outbreaks and incidents
involving controlled substances that were
tampered with by healthcare providers. Some
of these have involved providers swapping out
new syringes filled with narcotics for used
syringes filled with saline. The provider gets
the clean narcotics and the patient gets the
saline that has been contaminated by the
used syringe.
Syringe swaps might be easier to pull off
than one would think. Unattended syringes
drawn up for patient treatment become targets for swaps. Once a technician or other
staff member acquires a used syringe—from
scavenging red box waste, for example—it
can be a simple matter for them to create a
decoy syringe filled with saline solution. In
the absence of tamper-evident packaging
and clear labeling, the decoy syringe may
appear to be the real thing.
As outbreak investigations have shown,
these dangerous practices can readily transmit
infection from a hepatitis C virus-infected
provider to large numbers of patients. Patient
harm can also include substandard care
delivered by an impaired provider, denial of
appropriate therapy or pain control, as well
as serious infection risks.
How often is this occurring? It is hard to
say with certainty, but fentanyl—a narcotic
pain medication—is a commonly abused
drug across healthcare. Likewise, recognition of contaminated injections as a source
of hepatitis and other infections is growing.
CDC is aware of dozens of U.S. outbreaks
that identified unsafe injection practices
as the root cause. Of these outbreaks, four
involved fentanyl tampering.
When investigations of narcotics loss indicate possible tampering with injectable medications, facilities should pursue bloodborne
pathogen testing of any implicated worker
to better assess patient risks. Institutional
policies that establish for-cause drug testing of staff should be reviewed. Screening
panels should include the actual types of
controlled substances, such as fentanyl, that
may have been targeted. Facilities should also
consider examining options for establishing
authorities for bloodborne pathogen testing
in this context.
Prevention is key. Healthcare institutions
need more effective systems for maintaining narcotics security. Patient safety and
professional safety all demand effective,
reliable safeguards to maintain the integrity of prescription drugs and controlled
substances. Active monitoring as well as
educating clinicians are important components of a drug diversion prevention program. Risk managers should be aware of
requirements from the Drug Enforcement
Administration and the Food and Drug
Administration pertaining to reporting
requirements and effective controls to
guard against theft.
Maintaining the security of controlled
substances is a shared responsibility.
Working together, we can raise awareness
and strengthen protections in this area.
r. Joseph Perz is the Quality
D
Standards and Safety team leader
for the Division of Healthcare
Quality Promotion at Centers for
Disease Control and Prevention
in Atlanta, Georgia.
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