title: Reuse of insulin pens among multiple patients at 2 Veterans Affairs medical centers.
abstract: OBJECTIVE
  To determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two Veterans Affairs medical centers.
  
  
  METHODS
  Veterans who received insulin via insulin pens from 2010 to 2013. METHODS Patients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing.
  
  
  RESULTS
  Of 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness.
  
  
  CONCLUSIONS
  Our investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schirmer
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Winston
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lucero-Obusan
authors.affiliation: 2Stanford University,Stanford,California.
authors.forename: Mark
authors.initials: M
authors.lastname: Winters
authors.affiliation: 3Veterans Affairs Western New York Healthcare System,Buffalo Medical Center,Buffalo,New York.
authors.forename: Alan
authors.initials: A
authors.lastname: Lesse
authors.affiliation: 5W. G. "Bill" Hefner Veterans Affairs Medical Center,Salisbury,North Carolina.
authors.forename: Charles
authors.initials: C
authors.lastname: de Comarmond
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Gina
authors.initials: G
authors.lastname: Oda
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Martinello
authors.affiliation: 1Office of Public Health,Department of Veterans Affairs,Washington,DC.
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017848:Blood-Borne Pathogens; D003428:Cross Infection / Q000635:transmission*; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006509:Hepatitis B / Q000635:transmission; D006526:Hepatitis C / Q000635:transmission; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D061385:Insulins / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013594:Syringes / Q000706:statistics & numerical data*; D014481:United States; D058014:Veterans Health / Q000706:statistics & numerical data*; D014777:Virus Diseases / Q000635:transmission*
chemical_list: D007004:Hypoglycemic Agents; D061385:Insulins