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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 ([email protected]).
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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

REFERENCES

1. Healthcare inspection-inappropriate use of insulin pens VA Western New York Healthcare System Buffalo, New York. Report No. 13-01320-200. Department of Veteran Affairs Office of Inspector General website. http://www.va.gov/oig/pubs/VAOIG-13-01320-200.pdf. Published 2013. Accessed May 22, 2014.Google Scholar
2. Insulin pens and pen needles. BD Diabetes Learning Center website. http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7254. Accessed May 22, 2014.Google Scholar
3. Le Floch, JP, Herbreteau, C, Lange, F, Perlemuter, L. Biologic material in needles and cartridges after insulin injection with a pen in diabetic patients. Diabetes Care 1998;21:1502–1504.Google Scholar
4. Herdman, M, Larck, C, Schliesser, S, Jelic, T. Biological contamination of insulin pens in a hospital setting. Am J Health Syst Pharm 2013;70:1244–1248.CrossRefGoogle ScholarPubMed
5. Sonoki, K, Yoshinari, M, Iwase, M, et al. Regurgitation of blood into insulin cartridges in the pen-like injectors. Diabetes Care 2001;24:603–604.Google Scholar
6. Cross contamination with insulin pens. ISMP Medication Safety Alert website. http://www.ismp.org/newsletters/acutecare/articles/20080327_1.asp. Published 2008. Accessed May 22, 2014.Google Scholar
7. Considering Insulin pens for routine hospital use? ISMP Medication Safety Alert website. http://www.ismp.org/newsletters/acutecare/articles/20080508.asp. Published 2008. Accessed May 22, 2014.Google Scholar
8. Reuse of insulin pen for multiple patients risks transmission of bloodborne disease. ISMP Medication Safety Alert website. http://www.ismp.org/newsletters/acutecare/articles/20090212-2.asp. Published 2009. Accessed May 22, 2014.Google Scholar
9. Information for healthcare professionals: risk of transmission of blood-borne pathogens from shared use of insulin pens. US Food and Drug Administration website. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm133352.htm. Published 2009. Accessed May 22, 2014.Google Scholar
10. Insulin pens must never be used for more than one person. Centers for Disease Control and Prevention Clinical Reminder website. http://www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html. Published 2012. Accessed May 22, 2014.Google Scholar
11. AL No. 13-04-Multi-dose pen injectors. VA Patient Safety Alert website. http://www.patientsafety.va.gov/docs/alerts/AL13-04MultiDosePens.pdf. Published 2013. Accessed May 22, 2014.Google Scholar
12. Healthcare inspection—review of veterans health administration follow-up on inappropriate use of insulin pens at medical facilities. Report No 13-01987-263. Department of Veteran Affairs Office of Inspector General website. http://www.va.gov/oig/pubs/VAOIG-13-01987-263.pdf. Published 2013. Accessed March 24, 2015.Google Scholar
13. VHA Directive 1058. Office of Research and Oversight website. http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1825. Published 2009. Accessed September 25, 2014.Google Scholar
14. Sullivan, KM, Dean, A, Soe, MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep 2009;124:471–474.Google Scholar
15. Bukh, J, Miller, RH, Purcell, RH. Genetic heterogeneity of hepatitis C virus: quasispecies and genotypes. Semin Liver Dis 1995;15:41–63.Google Scholar
16. Kato, N. Genome of human hepatitis C virus (HCV): gene organization, sequence diversity, and variation. Microb Comp Genomics 2000;5:129–151.Google Scholar
17. Cody, S, Nainan, O, Garfein, R, et al. Hepatitis C virus transmission from an anesthesiologist to a patient. Arch Intern Med 2002;162:345–350.Google Scholar
18. Nainan, O, Alter, M, Kruszon Moran, D, et al. Hepatitis C virus genotypes and viral concentrations in participants of a general population survey in the United States. Gastroenterology 2006;131:478–484.Google Scholar
19. Patel, P, Larson, AK, Castel, A, et al. Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies. JAMA 2006;296:2005–2011.Google Scholar
20. Ramachandran, S, Xia, G-L, Ganova Raeva, L, Nainan, O, Khudyakov, Y. End-point limiting-dilution real-time PCR assay for evaluation of hepatitis C virus quasispecies in serum: performance under optimal and suboptimal conditions. J Virol Methods 2008;151:217–224.Google Scholar
21. Thompson, ND, Hellinger, WC, Kay, RS, et al. Healthcare-associated hepatitis C virus transmission among patients in an abdominal organ transplant center. Transpl Infect Dis 2009;11:324–329.Google Scholar
22. Hakre, S, Upshaw Combs, D, Sanders Buell, E, et al. An investigation of bloodborne pathogen transmission due to multipatient sharing of insulin pens. Mil Med 2012;177:930–938.CrossRefGoogle ScholarPubMed
23. Nassau University Medical Center press release. Nassau University Medical Center website. http://www.nuhealth.net/pressreleasedetail.asp?ID=340. Published 2008. Accessed May 22, 2014.Google Scholar
24. Dean Clinic says patients may have been exposed to hepatitis, HIV. Wisconsin State Journal website. http://host.madison.com/news/local/health_med_fit/dean-clinic-says-patients-may-have-been-exposed-to-hepatitis/article_5806e8b6-d261-11e0-8dcb-001cc4c002e0.html. Published 2011. Accessed July 6, 2015.Google Scholar
25. Olean General Hospital press release. Olean General Hospital website. http://www.ogh.org/programs-and-services/diabetes/Press%20Release-OGH%20Alerts%20Patients%20to%20Possible%20Insulin%20Pen%20Re-use.pdf. Published 2013. Accessed May 22, 2014.Google Scholar
26. Kuehn, B. FDA warns against shared insulin pens. JAMA 2009;301:1527.Google Scholar
27. Ochs, R. Nassau Medical Center extends warning over insulin pen. Newsday website. http://www.diabeticconnect.com/diabetes-news/general/324-nassau-medical-center-extends-warning-over-insulin-pen. Published 2008. Accessed May 22, 2014.Google Scholar
28. Griffin Hospital news release. Griffin Hospital alerts patients to possible insulin pen misuse. Griffin Hospital website. http://www.griffinhealth.org/About-Us/News-Releases/Post/8018/Insulin-Pen-Notification. Published 2014. Accessed June 19, 2014.Google Scholar
29. US Preventive Services Task Force. Infectious diseases recommendations for hepatitis B virus, hepatitis C virus and human immunodeficiency virus. US Preventive Services Task Force website. http://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Published 2013-2014. Accessed June 12, 2015.Google Scholar
30. Viral hepatitis. Department of Veterans Affairs website. http://www.hepatitis.va.gov/provider/index.asp. Published 2015. Accessed July 8, 2015.Google Scholar
31. Czarnogorski, M, Halloran Cns, J, Pedati, C, et al. Expanded HIV testing in the US Department of Veterans Affairs, 2009-2011. Am J Public Health 2013;103:e40–e45.Google Scholar
32. Backus, LI, Belperio, PS, Loomis, TP, Mole, LA. Impact of race/ethnicity and gender on HCV screening and prevalence among U.S. veterans in Department of Veterans Affairs Care. Am J Public Health 2014;104:S555–S561.Google Scholar
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