An infectious disease outbreak may occur if a healthcare worker is diverting opioid drugs. A sudden increase in infections may be the only clue that diversion is taking place.
Organisms involved in outbreaks have included:
(1) gram-negative bacteremia
(2) hepatitis C virus (HCV)
(3) hepatitis B virus (although healthcare worker vaccination makes this unlikely)
The infection may occur as a result of:
(1) tampering with an infusion pump
(2) injecting from a syringe then refilling with normal saline for patient use
(3) contaminating a sterile container that will be used later on a patient
The investigation entails:
(1) dates of service for the affected patients
(2) locations where the patient was scheduled
(3) work schedules of employees
(4) records of key access by employees
(5) behavior of a worker that may suggest drug misuse
(6) testing of employees for the implicated infectious agent
(7) drug testing of employees including hair testing
For a bloodborne virus an isolate from an employee can be compared to the patient isolates thereby directly implicating the employee. For bacterial contamination such confirmation may not be possible.
Such episodes can be avoided by:
(1) strict narcotic security measures
(2) active monitoring of healthcare workers
(3) close followup of patients
