Schaefer Melissa K, Perz Joseph F
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Mayo Clin Proc. 2014 Jul;89(7):878-87. doi: 10.1016/j.mayocp.2014.04.007. Epub 2014 Jun 2.
To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions.
We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation.
We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing.
These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.
总结美国医疗环境中因药品挪用引发感染暴发的现有信息，并描述推荐的方案和公共卫生行动。
我们查阅了疾病控制与预防中心（Centers for Disease Control and Prevention）的记录，这些记录涉及2000年1月1日至2013年12月31日期间美国医疗环境中医护人员因药品挪用导致感染暴发的情况。同时还使用PubMed搜索了同一时期发表的医学文献。收集的信息包括医疗环境、感染类型、涉案医护人员的专业、涉案药物、挪用机制、感染患者数量、可能接触血源性病原体的患者数量以及调查结果。
我们在始于2004年的10年期间内确定了6起暴发事件；所有事件均发生在医院环境中。涉案医护人员包括3名技术人员和3名护士，其中一名是麻醉护士。感染传播的机制是篡改注射用管制药品。两起暴发事件涉及篡改通过患者自控镇痛泵给药的阿片类药物，导致34名患者发生革兰氏阴性菌血症。其余4起暴发事件涉及篡改装有芬太尼的注射器或药瓶；丙型肝炎病毒感染传播给了84名患者。在每起此类暴发事件中，涉案医护人员均感染了丙型肝炎病毒并成为传染源；近30000名患者可能接触了血源性病原体，并被作为目标进行通知以建议检测。
这些暴发事件揭示了美国医疗设施在预防、检测和应对药品挪用方面存在的差距。医疗设施通过实施强有力的麻醉药品安全措施和积极的监测系统，能最好地预防药品挪用。适当的应对措施包括评估对患者的危害、在怀疑篡改注射用药物时与公共卫生官员协商以及及时向执法机构报告。
