MMWR Morb Mortal Wkly Rep. 2019 Apr 26;68(16):374-376. doi: 10.15585/mmwr.mm6816a3.
During January 22-March 23, 2018, a local health department in Washington was notified of two patients who received a diagnosis of acute hepatitis C virus (HCV) infection. Neither patient had behavioral risk factors associated with HCV acquisition; however, both had received injectable narcotic (opioid) drugs from the same nurse during separate visits to an emergency department (ED) at a local hospital on December 6 and December 16, 2017. Investigation revealed that the nurse had accessed the automated drug dispensing system at a higher frequency than had other staff members, admitted diverting* patients' injectable narcotic and antihistamine drugs for personal use, and tested positive for HCV antibodies (anti-HCV) on March 19, 2018, but did not have quantifiable HCV RNA. Specimens from both patients were sent to CDC for genetic testing, and HCV viral variants analysis found a significant level of genetically similar HCV variants in both patients, indicating a common source of infection. Further investigation was conducted to confirm the infection source, identify other potentially exposed patients, and treat any new patients who received an HCV diagnosis. Monitoring frequency of access to drug dispensing systems can help identify staff members with abnormal dispensing patterns, including diversion activities (1). U.S. health care facilities are required to prevent, identify, and report any loss, diversion, or theft of controlled substances (2).
2018 年 1 月 22 日至 3 月 23 日，华盛顿州的一个地方卫生部门接到通知，称有两名患者被诊断出患有急性丙型肝炎病毒（HCV）感染。这两名患者均无与 HCV 感染相关的行为风险因素；然而，他们都曾于 2017 年 12 月 6 日和 12 月 16 日在当地一家医院的急诊室（ED）接受过同一名护士提供的注射类麻醉（阿片类）药物。调查显示，该护士的自动配药系统访问频率高于其他工作人员，承认私自挪用患者的注射类麻醉药和抗组胺药物供个人使用，并于 2018 年 3 月 19 日 HCV 抗体（抗-HCV）检测呈阳性，但 HCV RNA 未定量。两名患者的标本均被送往 CDC 进行基因检测，HCV 病毒变异分析发现两名患者的 HCV 病毒变异具有显著的相似性，表明存在共同的感染源。进一步的调查旨在确认感染源、识别其他潜在的受感染患者，并对任何新诊断出 HCV 感染的患者进行治疗。监测配药系统的访问频率有助于识别有异常配药行为的工作人员，包括药物挪用活动（1）。美国卫生保健机构有责任预防、发现和报告任何受控物质的损失、挪用或盗窃（2）。
