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Drug Diversion Defined: A Patient Safety Threat

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the National Association of Drug Diversion Investigators

You may have seen some recent media reports about drug diversion. Today, I want to break down the issue of drug diversion and provide some details about this serious patient safety threat.

Drug diversion, or theft of drugs, by healthcare personnel poses a continuous threat to patient safety in any healthcare setting in which controlled substances are handled. Although personnel who divert originally went into healthcare to care for patients, they have made poor choices for which they are accountable, including the impact their actions have on others. The longer a healthcare worker is allowed to steal medication, the greater the consequences become. Impaired providers can harm patients by providing sub-standard care, denying medications to patients, or exposing patients to tainted substances.

Tampering is the worst type of diversion. Commonly, the diverter removes medication from a syringe, vial, or other container and injects him- or herself with the medication. The diverter then replaces the stolen medication with saline or sterile water, or another clear medication or liquid. The “replacement liquid” is later used on the patient by an unaware provider. When tampering, the diverter may rarely use sterile technique. Ultimately the patient doesn’t receive the required medication and may be exposed to the diverter’s blood.

Outbreaks Highlight Infection Risks Associated with Drug Diversion

Categories: Injection Safety

Joseph Perz, DrPH, MA

Joseph Perz, DrPH, MA

Author: Joseph Perz, DrPH, MA
Quality Standards and Safety Team Leader
for the Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention

When prescription medicines are stolen or used illegally, it is called drug diversion.

Prescription opioid addiction has reached epidemic proportions and is a major driver of drug diversion. One aspect of drug diversion that is not well recognized involves healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms. These include:

  • Substandard care delivered by an impaired healthcare provider,
  • Denial of essential pain medication or therapy, or
  • Risks of infection (hepatitis C virus, hepatitis B virus, HIV, bacterial infection) if a provider tampers with injectable drugs.

Cancer Survivor Employs Simple Steps to Fight off Infection During Chemotherapy

Categories: Hand Hygiene, Healthcare-associated infections, Outpatient Care, Patients

Pamela Bryant and family

Pamela Bryant and family

Author: Pamela Bryant, MS
Health Communications Specialist, CDC

To do:

  • Biopsy
  • MRI
  • Port-a-Cath
  • Chemotherapy
  • Genetic Testing
  • Lumpectomy
  • Radiation

The above list is not exactly the type of to-do list I ever thought I’d be faced with. As you can imagine, this list of tests, screenings, procedures, and treatments was a bit overwhelming as I was diagnosed last October with a Stage II breast cancer. Not only did I learn I had triple negative breast cancer, but I had to accept that my treatment plan would definitely include chemotherapy—8 rounds to be exact—followed by surgery and radiation. My life and my family’s life was about to change during this time. So we talked and prayed, and then we prepared for this journey.

As a “CDC-er,” my work as a health communications specialist often involves taking what our team of scientists knows and putting it into easy-to-understand language for the general public. So after I learned that I had cancer and was trying to prepare myself and my family for what was to come, I read about one of chemotherapy’s most serious side effects that I had never heard of before – neutropenia. Almost instantly, my CDC background kicked in. First of all, I thought, “how do you even pronounce this word (new-tro-pee-nee-a, by the way),” and secondly, “how can I explain the seriousness of this to my family?”

Pamela Bryant, MS

Pamela Bryant, MS

Once I did a little digging, I found an excellent resource (right in my back yard!) that explained this condition to my family and me. PreventCancerInfections.org is a web site developed by CDC that provides practical steps that patients and caregivers can take to prevent infections. This website also helps explain what neutropenia is (a low white blood cell count), how and why it makes you more likely to get an infection, and what you and your family can do to help protect yourself.

Ironically, my CDC job involves communicating about basic principles of maintaining good health, such as frequent hand washing and safe food preparation. Fortunately, these practices came naturally for me, but I kicked them into high gear while I was receiving chemotherapy.

One of Chemotherapy’s Most Severe Side Effects: What You Can Do To Prevent An Infection During Treatment For Cancer

Categories: Healthcare-associated infections, Outpatient Care

Michele E. Gaguski MSN RN AOCN CHPN APN-C

Michele E. Gaguski MSN RN AOCN CHPN APN-C

Author: Michele E. Gaguski
MSN RN AOCN CHPN APN-C

As an oncology nurse, I often see anxiety and fear in the eyes of my patients as I  teach them what to expect from their first round of chemotherapy.  Most of the time, patients’ first questions are about the more visible side effects of their treatment:  “Will I lose my hair?” “Will the chemo make me nauseous?”

While all of these are very real and important, none of them may be as life threatening as getting an infection.  Having a low white blood cell count is one of the most serious side effects of chemotherapy.

Here’s how it works:  if you have cancer and are undergoing chemotherapy treatment, the chemotherapy drugs work by killing the cancer cells in your body. However, they also kill the good cells, like your infection-fighting white blood cells.  When this happens and your white blood cell count dips too low, your immune system takes a hit as well, increasing your risk of infection.  This condition, called neutropenia, is common after receiving chemotherapy.

It’s important for patients with cancer to know that getting an infection is an emergency and should be treated as one.  In fact, it’s estimated that each year 60,000 cancer patients are hospitalized for chemotherapy-related infections and one patient dies every two hours from this complication.

Picking a Fight with Multidrug-Resistant Gram-Negative Organisms

Categories: Healthcare-associated infections

Ebbing Lautenbach MD, MPH, MSCE

Ebbing Lautenbach MD, MPH, MSCE

Author: Ebbing Lautenbach MD, MPH, MSCE

Over the last decade, the incidence of multidrug resistance in gram-negative pathogens has steadily increased, yet there has not been any increase in antimicrobial development to address these organisms.  The potential for widespread and rapid transmission of the pathogens is concerning as is the growing prevalence of these organisms in all aspects of patient care – acute care hospitals, long-term acute care hospitals, long-term care and the community .   With their emergence, it has become even more critical to preserve the viability of our current antimicrobials through strong stewardship programs such as those promoted in the recent CDC Vital Signs Report.

Beyond that we need to specifically target Multidrug-Resistant Gram-Negative Organisms or MDROs to create a national and even global response that makes scientific sense to effectively combat this problem.  In the April 2014 special issue of Infection Control and Hospital Epidemiology we published studies that take a critical look at MDROs.  The papers highlighted in this issue provide insights on current practices and raise questions to guide future scientific studies in this research area.   While more research still needs to be done,  these studies help to better define the scope of the problem and understand how different hospitals and healthcare workers approach these organisms including how facilities control the spread of these pathogens.  Applying this research to inform our current practices in order to improve patient outcomes is critical as we wage this battle with MDROs.

Yet with so many areas of Healthcare Associated Infections (HAIs) being interdependent it is impossible to address the issue of MDROs without pairing it with overall good HAI prevention such as antimicrobial stewardship, environmental cleaning, hand hygiene, and more.    It is also careless to only consider this problem in the acute care setting, as the frequent transfer of patients between different healthcare facilities is a crucial element of the problem.  As a healthcare system, we need to promote and develop evidence-based interventions for MDROs and other supplemental infection prevention interventions to defeat MDROs while saving lives and decreasing healthcare costs overall.

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