A 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.