title: Outbreaks of infections associated with drug diversion by US health care personnel.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: mschaefer@cdc.gov.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Schaefer
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D018563:Disease Notification; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D008297:Male; D061214:Patient Safety; D010564:Personnel, Hospital; D064226:Prescription Drug Diversion / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology