title: Outbreak of hepatitis C virus infection associated with narcotics diversion by an hepatitis C virus-infected surgical technician.
abstract: BACKGROUND
  Drug diversion by health care personnel poses a risk for serious patient harm. Public health identified 2 patients diagnosed with acute hepatitis C virus (HCV) infection who shared a common link with a hospital. Further investigation implicated a drug-diverting, HCV-infected surgical technician who was subsequently employed at an ambulatory surgical center.
  
  
  METHODS
  Patients at the 2 facilities were offered testing for HCV infection if they were potentially exposed. Serum from the surgical technician and patients testing positive for HCV but without evidence of infection before their surgical procedure was further tested to determine HCV genotype and quasi-species sequences. Parenteral medication handling practices at the 2 facilities were evaluated.
  
  
  RESULTS
  The 2 facilities notified 5970 patients of their possible exposure to HCV, 88% of whom were tested and had results reported to the state public health departments. Eighteen patients had HCV highly related to the surgical technician's virus. The surgical technician gained unauthorized access to fentanyl owing to limitations in procedures for securing controlled substances.
  
  
  CONCLUSIONS
  Public health surveillance identified an outbreak of HCV infection due to an infected health care provider engaged in diversion of injectable narcotics. The investigation highlights the value of public health surveillance in identifying HCV outbreaks and uncovering a method of drug diversion and its impacts on patients.
authors.affiliation: Division of Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO. Electronic address: Amy.warner@state.co.us.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Warner
authors.affiliation: Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Schaefer
authors.affiliation: Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.affiliation: Assay Development and Diagnostic Reference Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Jan
authors.initials: J
authors.lastname: Drobeniuc
authors.affiliation: Molecular Epidemiology Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Guoliang
authors.initials: G
authors.lastname: Xia
authors.affiliation: Molecular Epidemiology Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Molecular Epidemiology Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Yury
authors.initials: Y
authors.lastname: Khudyakov
authors.affiliation: Division of Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO.
authors.forename: Candace W
authors.initials: CW
authors.lastname: Vonderwahl
authors.affiliation: Division of Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO.
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.affiliation: Epidemiology and Surveillance Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Nicola D
authors.initials: ND
authors.lastname: Thompson
mesh_terms: D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005838:Genotype; D006282:Health Personnel; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D017422:Sequence Analysis, DNA; D019966:Substance-Related Disorders / Q000150:complications*
keywords: Drug theft in healthcare; Healthcare associated infections; Unsafe injection practice