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Reuse of Insulin Pens Among Multiple Patients at 2 Veterans Affairs Medical Centers

Published online by Cambridge University Press:  22 July 2015

Patricia Schirmer ,
Carla A. Winston ,
Cynthia Lucero-Obusan ,
Mark Winters ,
Alan Lesse ,
Charles de Comarmond ,
Gina Oda ,
Richard A. Martinello  and
Mark Holodniy
Patricia Schirmer*
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC
Carla A. Winston
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC
Cynthia Lucero-Obusan
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC
Mark Winters
Affiliation:
Stanford University, Stanford, California
Alan Lesse
Affiliation:
Veterans Affairs Western New York Healthcare System, Buffalo Medical Center, Buffalo, New York University at Buffalo, Buffalo, New York
Charles de Comarmond
Affiliation:
W. G. “Bill” Hefner Veterans Affairs Medical Center, Salisbury, North Carolina
Gina Oda
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC
Richard A. Martinello
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC Yale School of Medicine, New Haven, Connecticut
Mark Holodniy
Affiliation:
Office of Public Health, Department of Veterans Affairs, Washington, DC Stanford University, Stanford, California
*
Address correspondence to Patricia Schirmer, MD, Office of Public Health Surveillance and Research, 3801 Miranda Ave (132), Palo Alto, CA 94304 (Patricia.Schirmer@va.gov).
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Abstract

OBJECTIVE

To determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP).

DESIGN

Retrospective cohort study.

SETTING

Two Veterans Affairs medical centers.

PATIENTS

Veterans who received insulin via insulin pens from 2010 to 2013.

METHODS

Patients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing.

RESULTS

Of 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness.

CONCLUSIONS

Our investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.

Infect Control Hosp Epidemiol 2015;36(10):1121–1129

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 10 , October 2015 , pp. 1121 - 1129
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Presented in part: IDWeek 2014; Philadelphia, Pennsylvania; October 11, 2014 (abstract 1730).

The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

References

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