title: An investigation of bloodborne pathogen transmission due to multipatient sharing of insulin pens.
abstract: On January 30, 2009, nursing staff at a military hospital in Texas reported that single-patient use insulin pens were used on multiple patients. An investigation was initiated to determine if patient-to-patient bloodbome transmission occurred from the practice. Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) testing was offered to patients hospitalized from August 2007 to January 2009 and prescribed insulin pen injections. Virus from HCV-infected patients' sera was sequenced and compared for relatedness. An anonymous survey was administered to nurses. Of 2,113 patients prescribed insulin pen injections, 1,501 (71%) underwent testing; 6 (0.4%) were HIV positive, 6 (0.4%) were hepatitis B surface antigen positive, and 56 (3.7%) had HCV antibody. No viral sequences from 10 of 28 patients with newly diagnosed and 12 of 28 patients with preexisting HCV infection were closely related. Of 54 nurses surveyed, 74% reported being trained on insulin pen use, but 24% believed nurses used insulin pens on more than one patient. We found no clear evidence of bloodborne pathogen transmission. Training of hospital staff on correct use of insulin pens should be prioritized and their practices evaluated. Insulin pens should be more clearly labeled for single-patient use.
authors.affiliation: Epidemiology and Threat Assessment, U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 400, Bethesda, MD 20817, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Hakre
authors.forename: Donna R
authors.initials: DR
authors.lastname: Upshaw-Combs
authors.forename: Eric E
authors.initials: EE
authors.lastname: Sanders-Buell
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Scoville
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Kuper
authors.forename: Linda L
authors.initials: LL
authors.lastname: Jagodzinski
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Bradfield
authors.forename: Dinae C
authors.initials: DC
authors.lastname: Davison
authors.forename: William G
authors.initials: WG
authors.lastname: Callis
authors.forename: Angela B
authors.initials: AB
authors.lastname: Owens
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Michael
authors.forename: Robert J
authors.initials: RJ
authors.lastname: O'Connell
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Peel
authors.forename: John W
authors.initials: JW
authors.lastname: Gardner
authors.forename: Nicola D
authors.initials: ND
authors.lastname: Thompson
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Hu
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Kim
authors.forename: Sodsai
authors.initials: S
authors.lastname: Tovanabutra
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Sandra G
authors.initials: SG
authors.lastname: LaFon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000635:transmission*; D004209:Disposable Equipment; D016503:Drug Delivery Systems / Q000295:instrumentation*; D005260:Female; D015658:HIV Infections / Q000235:genetics / Q000635:transmission*; D006509:Hepatitis B / Q000235:genetics / Q000635:transmission*; D006526:Hepatitis C / Q000235:genetics / Q000635:transmission*; D006772:Hospitals, Military; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007279:Injections, Subcutaneous / Q000295:instrumentation; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000235:genetics; D013781:Texas; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D012367:RNA, Viral