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Subscribe to RSSA shortage of properly packaged drugs could be putting patients at risk, federal health officials said on Thursday. They warned about clinics giving injections to more than one patient from vials designed for use for just one patient.
Ten patients in Arizona and Delaware were hospitalized with serious infections they got when clinic staff injected them with drugs taken from vials meant for one-time use in recent months, the Centers for Disease Control and Prevention said. Another patient was found dead at home after getting one of the injections, although it couldn’t be proven the infection killed the patient. Last April, staff at one clinic in Delaware managed to infect nine patients with bacteria from their own bodies.
The CDC said the cases illustrate a growing problem -- there have been 20 such incidents since 2007.
Staff at both clinics said they had trouble getting specially designed vials for multiple uses, the CDC said. There have been nationwide shortages of some of the drugs because of manufacturing problems. So staff diluted single-dose packages and used them in several patients, spreading infection. “Medications labeled as ‘single dose’ or ‘single use’ typically are preservative-free and should be dedicated for single-patient use to protect patients from infection risks,” the team of investigators wrote in the CDC’s weekly report on death and disease.
At one clinic in Arizona, staffers diluted a vial of contrast agent, used to help make x-rays clearer when preparing patients for injections of strong pain medications. They injected 10 patients from this one diluted vial. Three patients were infected with methicillin-resistant Staphylococcus aureus, also known as MRSA, a serious and hard-to-treat bacterial infection.
All had to be hospitalized with meningitis, blood infections or abcesses – one for 41 days. “The fourth recipient of diluted contrast from the afternoon vial was found deceased at home, six days after treatment at the clinic. The cause of death was reported as multiple-drug overdose; however, invasive MRSA infection could not be ruled out,” the health officials wrote.
In Delaware, seven patients ended up in the hospital for three to eight days after getting injections for joint pain from the same orthopedic clinic last March. “When a national drug shortage disrupted the supply of 10 mL single dose vials, office staff members began using 30 mL single dose vials of bupivacaine for multiple patients,” the investigators wrote.
CDC experts tested the patients and they all were infected with an identical strain of S. aureus – and it matched a strain found living in two of the clinic workers. The workers were colonized – meaning the bacteria lived in their noses or on their skin but didn’t make them sick.
“This report reminds health-care providers of the serious consequences of multipatient use of single-dose vials that can occur even when health-care workers believe they are being careful,” the report reads. There are ways to safely use smaller vials for multiple patients, but the CDC and state health officials in Arizona and Delaware said clinic staff need special training.
How can patients protect themselves? Infection control experts say it's best to be a squeaky wheel -- always ask doctors, nurses and other clinic staff if they have washed their hands before touching you. Patients receiving injections should ask if the equipment is sterile and if it has been prepared according to procedure. And anyone who has been to a clinic or hospital recently should immediately check with a doctor if they develop a fever, rash or cough.
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Your advice is to ask a doctor or nurse if they've washed their hands before examining you, whether equipment is sterile, and whether injectables have been prepared according to proper procedure? What exactly do you think they are going to say??
Anyone who takes a medication manufactured for single use and uses it on multiple patients should lose whatever license or certification they have and should face criminal charges from any patient harm that results.
I think you need to be a little more tolerant on the use of a single use vial for multiple patients. In a hospital setting, with proper procedures, this can be done relatively safely. With the drug shortages it often came down to doing this or having some people not get needed medication. When there is a shortage of a drug that your patients need 10ml of and all you have are 30ml vials you are not going to use 10ml out of the 30ml vial and waste the rest, particularly not if this means that some patients will not get any medication at all.
The main reason for single use vials is that these vials usually contain medication that has no preservative in it. This means that the drug will go bad relatively quickly once the seal is broken to draw a dose. So long as subsequent doses from these vials are drawn fairly soon and good sterile procedures are used, there is really minimal risk with using the same vial to dose multiple patients. I say minimal, because there is no such thing as no risk, but the risk here would be no greater than any other injectable dose draw.
As for medical personnel washing their hands, my doctor has a sink in every exam room in his office and makes a point of washing his hands as soon as he comes into the room to see each patient.
Agreed. They put patients at risk and should be put in jail.
This is pretty basic stuff, if they can't get this right it's time to start revoking licenses and shut down these "rogue" clinics.
I ask doctors and nurses if they've washed their hands and remind them that I have taken immune-suppressing drugs. Even if they say they've just washed their hands, most will wash them again in front of me or squirt on antibacterial hand liquid/foam.
What I wish is that healthcare facilities wiped down their waiting rooms and chairs with antibacterials more frequently and make sure that each pen they give patients to write with has been cleaned after someone else wrote with it. Pharmacies are also filled with germ-ridden people and should be frequently wiping down their chairs, counters, and pens.
Don't forget about wiping down "door knobs" to the individual patient waiting rooms and "keyboards and mice" that are in the waiting rooms for doctors and nurses to use for data entry about the patients!
Yes oh yes this is the health care legacy we are passing on to our children at tremendous expense. People who either don't know or don't care what they are doing or what they can create in a patient looking for medical care. So what sort of idiot thinks it is reasonable to dilute a dose of medication? Are they diluting what they charge patients or insurance companies? Are they diluting their own common sense or intelligence?
Now I understand why so many people cry for single payer health care....the industry seems to already have a handle on reduced care and medical knowledge they might as well get paid accordingly.
I knew *someone* would bring politics into the picture.
Not politics....policy. They diluted medication. They used the same vials on multiple patients. They did what they pleased without regard for any protocol. This is a huge problem and we are going to see more of this. What is the point of giving a diluted medication? It is easy to say "oh there is a shortage so we killed the patient or gave the MRSA...oops we did our best. Their best was obviously not good enough. They lied and cheated each patient and their medical care coverage.
They knew what they were doing and knew it was wrong and they will try to pass the buck but honestly the buck stops with the person who administered the meds.
If you ask your doctor to wash his/her hands in front of you, most will comply. Don't rely on the use of hand sanitizer, it won't kill everything--for example, C. Diff, which causes severe GI problems and is very common in hospitals and nursing homes, is NOT killed by hand sanitizer! Frequent hand washing is key! Also, your doctor should wash his/her hands after removing rubber gloves and putting on new gloves. Bacteria thrive in the warm, moist environment of the gloved hand, and if not washed off will contaminate the outside of the new gloves that are put on next!
Sounds like something out of China.
More than likely influence from a vocational program in a US high school.
I wouldn't trust those "staff" members to pick up my trash ! JAIL them ! Sounds like those kids that pass out the pills at assisted living after a few hours of training.
www.Healthcareinfection.com is a web resurce about hospital infections written for patients.
www.healthcareinfection.com has information about hospital infections, what can be done to prevent hospital infections and well as details on when hospitals fail to prevent infections.
After a careful read of this article, it seems to me that the basic problem is not health care professional's behavior but the SHORTAGES OF VITAL DRUGS! Many of you are condemning, judging and wishing punishment and condemnation on people to just want to be of service and save lives. They are doing their jobs the best way they know how with limited resources.
Why do Americans lash out and savagely attack each other this way? The people who keep the wheels of our civilization working are turning on each other, instead of coming together in mutual respect and cooperation to actually solve a problem that is killing people. The ones you need to go to and demand answers from, and accountability for this, are not wearing scrubs. They are wearing three-piece suits and they won't empty your bed pan.
becoming-galactic---its health care "professionals" that do not understand germ transmission that kill people. They are not good intentioned- they are sloppy and careless and get paid regardless of their mistakes. It is not the best way they know how. They should have cleaned the vials with alcohol pads, there are ways to prevent germ transmission. Not all healthcare professionals are sloppy but many of them are.
Really, its nice for this article to suggest to ask them to make sure they followed procedures----- I have asked health care workers to wash their hands/santize their hands- they lie, they said they did, when you know they didn't, they get defensive, they get hostle, they treat you badly after you ask them. My one month old daughter died because of nurses and other hospital care givers were sloppy, careless, and "opps, we are so sorry.....blah blah..." They gave her a deadly bacteria. It was horrible. It was preventable. It's amazing with all the schooling medical personal in hospitals have to have and they still don't seem to understand germ transmission. Bottom line, they don't care, they get paid the same whether the patient lives or dies. It's disgusting.
I a so sorry for your loss
when loved ones are hospitalized I put up on the wall or on a pole (if the hospital hasn't already)
PLEASE WASH YOUR HAND BEFORE TOUCHING XXXX
thank you
in a place they can't ignore.
not that that necessarily would have prevented what happened to a child.
Becoming Galactic, thank you for what you said. Why do we lash out and attack so savagely?
It is so true, the "suits" hold the "workers" accountable for the money spent, it is the "suits" that think that money is more important than patient care. They smile to the patients face, and snarl at the workers for running up costs. As long as most of US health care is provided by 'for profit' Hospital Corporations the bottom line will be just that...profit. The 'for profits' produce slick brochures, and have beautiful buildings and settings; all of this 'fluff' is deductible, and is a depreciation write off for the Corporations. The REAL expenses are labor, drug, and equipment costs.
Experienced staff with tenure in a facility is the exception, rather than the rule now-days. Experienced staff may want to be paid what they are worth, and even (gasp) be treated with fairness and respect.