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Shame on us and everybody else.’
Communication failures between temporary employment agencies and hospitals allowed an HCV-positive temp worker to continue diverting drugs and infecting patients over several years at many different facilities, said Carlene Muto, MD, an infectious disease physician at the University of Pittsburgh Medical Center (UPMC).
"We have to hold these temporary agencies more accountable," she said recently in San Francisco at the IDWeek conference. "They must report to us any activity that would deem this person unemployable. Shame on us and everybody else. None of us reported it because we thought the temp agencies would report."
The temp worker was fired after only 47 days at UPMC after he was witnessed removing a syringe from an OR area. He subsequently tested positive for fentanyl. However, he went on to work at many different hospitals in at least five other states before he was arrested last year after being linked to a large HCV outbreak involving 32 patients at Exeter Hospital in New Hampshire. The temp worker apparently contaminated syringes and medication vials by using or removing the drugs and sometimes replacing them with saline or other liquids.
Discovering that the temp had worked at UPMC in 2008, Muto undertook a massive four-month investigation to identify possibly exposed patients and urge HCV testing. After testing of more than 800 patients, Muto found only one patient with an HCV strain that matched the temp. "He got tested three months after [the temp’s] employment," she said. "He had end-stage liver disease so he was not likely a new convertor."
Indeed, Muto theorizes that the liver disease patient actually infected the temp worker with HCV at UPMC in 2008.
"If [the temp] was HCV positive while working at our hospital more HCV cases would be expected," she said. "He may have become infected in 2008 — and I believe he did — during the end of his employment at UPMC. I actually think that our patient with end stage liver disease infected him."
The onus has traditionally been on the temp agencies to screen employees, Muto said, but "we can’t control necessarily what they do, so now we do have redundancies. We do all our own reporting, report to the temp agency, report to the FDA. Had we even been able to look through the FDA reports or agency reports we would have known that he was flagged already."
Such communication breakdowns are a "huge black hole" in drug-diversion infections, and more rigorous screening of workers by all parties needs to be done, said Kent Sepkowitz, MD, moderator of the IDWeek session.
"Often you need the temp so fast you don’t necessarily have time to do it, but I think we have to do a lot better as hospitals and demand [more accountability from temp agencies]," said Sepkowitz, an infectious disease physician at Memorial Sloan-Kettering Hospital in New York City.