Objectives

To summarize available information about outbreaks of infections stemming from drug diversion in U.S. healthcare settings and describe recommended protocols and public health actions.

Patients and Methods

We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by healthcare personnel in U.S. healthcare settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included healthcare setting(s), infection type(s), specialty of the implicated professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to bloodborne pathogens, and resolution of the investigation.

Results

We identified six outbreaks over a ten year period beginning in 2004; all occurred in hospital settings. Implicated healthcare professionals included three technicians and three nurses; one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining four outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus (HCV) infection was transmitted to 84 patients. In each of these outbreaks the implicated healthcare professional was infected with HCV and served as the source; nearly 30,000 patients were potentially exposed to bloodborne pathogens and targeted for notification advising testing.

Conclusions

These outbreaks revealed gaps in prevention, detection, and response to drug diversion in U.S. healthcare facilities. Drug diversion is best prevented by healthcare facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.