Transcript Siddiqui_2016_PHAP_Spring_Seminar_Presentation WITHOUT NOTES.pptx

Healthcare Associated Infections: Public Health
Implications of Drug Diversion Events
Kulsoom Siddiqui, MPH
CDC Public Health Associate
Office for State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention
PHAP Summer Seminar
May 16-20, 2016
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
What are HAIs?


Includes both bacterial infections
and viral infections
Central line-associated bloodstream
infections (CLABSI), catheter
associated urinary tract infections
(CAUTI), ventilator-associated
pneumonia, surgery sites, dialysis,
etc
 Can occur inadvertently to lapses in
hygiene, invasive medical procedures,
etc.
• Hand hygiene (#1 cause of disease
transmission)
Source: http://www.cdc.gov/HAI/infectionTypes.html
CDC HAI Estimates- 2011
Major Site of Infection
Estimated Number
Pneumonia
157,500
Gastrointestinal Illness
123,100
Urinary Tract Infection
93,300
Primary Bloodstream Infection
71,900
Surgical Site infections (outpatient surgery)
157,500
Other types of infections
118,500
Estimated total number of infections in
hospitals
721,800
Source: http://www.cdc.gov/hai/surveillance/index.html
What are drug diversions?

The CDC defines drug diversion as “illegally obtaining or
using prescribed medication for [personal] use”
Source: http://www.cdc.gov/injectionsafety/drugdiversion/ & NJDOH Injection Safety Training
Source: http://www.cdc.gov/injectionsafety/drugdiversion/ & NJDOH Injection Safety Training
CDC Drug Diversion Investigations
Source: http://www.cdc.gov/injectionsafety/drugdiversion/
DRUG DIVERSION IN NEW JERSEY
Drug Diversion in New Jersey

Former hospital employee positive
for a bloodborne pathogen found
to be diverting medication
 backfilling with saline before
administering product to patients

Patients at risk: recipients of
morphine drips, hydromorphone
analgesics, or hydromorphone
drips
Source:
http://www.cdc.gov/injectionsafety/unsafePractices.html
Drug Diversion in New Jersey
Clean needle
and syringe used
to draw
medication
Syringe contaminated
when used on
healthcare worker
MMWR; May 16, 2008; 57:19/NJ DOH Injection Safety Training
Reused syringe
contaminates
saline vial
Contaminated saline
administered to
patients
Patient Notification Method



Exposure period defined through security camera
surveillance and controlled substance cabinet reports
List of individuals who may have received the diverted
medications was compiled
After removing patients not at risk, patient notification
letters sent in February 2016 to at-risk individuals that
instructed them how to obtain blood tests
Results


213 individuals were notified
76% response rate - 163 have been tested:
 15 patients were positive for either HBV, HCV, or HIV
 To date, the individuals who tested positive have been previously
reported to NJ Department of Health and are not likely linked to the
diverter.
 22 patients lost to follow-up, with several additional patients from out
of state
Next Steps




Hospital staff will attempt to contact patients lost to follow
up & out of state patients
NJ DOH to determine if lost to follow up or out of state
patients were reported as positive
NJ DOH to investigate positive patients against reports in
CDRSS
Criminal investigation ongoing
Implications for Public Health


Collaboration/coordination
between partners
IMPERATIVE for successful
HAI outcomes
Public health ramifications
 Potential bloodborne
pathogen exposure
 Patient notification

Legal ramifications
Thank You!
Kulsoom Siddiqui
[email protected]
Acknowledgements:
Rebecca Greeley, Tabeth Jeri, Courtney Kirkland,
Jason Mehr, Ellen Rudowski, Laura Taylor
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support