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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Drug diversion by health workers can lead to HCV outbreaks

As we have seen in the recent past, medication drug diversion by health care workers can lead to an outbreak of hepatitis c virus, particularly if the addicted worker has become HCV infected through scavenging vials and reusing needles and syringes.

Hospitals increasingly are teaching managers to look for signs of drug abuse among employees, focusing on subtle clues like talk of financial problems or more blatant signs, such as arriving to work late or failing to show up as scheduled. Once there is suspicion of a problem, managers can refer the employee for a drug and alcohol screening test.

The biggest trigger for screening a health care worker for substance abuse is suspicion of drug diversion, says Jay D. Harper, MD, MBA, MPH, employee health services medical director at the University of Pittsburgh Medical Center.

“Drug diversion is the trigger that gets a lot of attention and is happening much more than it used to,” he says.

Hospitals increasingly are having employees drug-tested when there are problems of miscounted medications, not following procedures, and not being able to say what happened to missing medications, Harper says.

Here are a few suggestions for how to screen for drug diversion and handle the problem:

Require a blood-borne pathogen test: “When we do fitness for duty testing, we do blood-borne pathogen testing, checking for HIV, hepatitis B and C, because with diversion there have been cases where health care workers have been taking syringes and injecting themselves, and then giving them to a patient,” Harper explains. This practice may result in patients becoming infected, especially with hepatitis C, he adds. If the employee who is suspected of drug diversion tests positive for hepatitis C that matches the infected patient, then hospital officials have confirmation of drug diversion.

Involve other departments when diversion is suspected: Ask a human resources representative and the employee’s manager to be present as witnesses. The decision about requiring a blood-borne pathogen test should be made by HR and the manager – not employee health, Harper notes.

“The person suspected of diversion should always be accompanied by another person to employee health,” he explains. “We’ll do the testing and make sure the employee has transportation to return home.”

--Melinda Young

For more on this story see the July 2014 issue of Hospital Employee Health