1. Infection Prevention and Drug Diversion (What does drug diversion have to do with Infection Prevention?)
Aimee Russell, MLS(ASCP)
Infection Prevention
St. Luke’s Health System, Boise
February 2019

2. Special Thank you to Susan and APIC Puget Sound
for the great conference and opportunity to attend!

3. The Background

4. I don’t think we have this issue at my hospital…..?

6. How does this happen? Tampering and Substitution:
It often starts small and then builds as the
addiction deepens
Common Tactics:
Theft from Pyxis
Use of waste
Calling in prescriptions
Indicating it has been administered,
but diverting instead
Abuse of the culture of “helpers”
Tampering and Substitution:
Injectable opioid is self-administered and the volume is
replaced with saline, tap water or another substance

7. Okay, but what does that have to do with Infection Prevention?

8. More Cases:

9. Where do we even start?

13. “You don’t know what you don’t know”
Infection Prevention needs to be part of this process!
It can be very challenging to get involved because the cases are sensitive
IPs level of involvement varies widely among organizations

14. Oh, this really does include IP. Now what?
IP will be front and center if there is transmission of pathogens
Evaluation of patient harm
Blood Borne Pathogen testing
IP may be who identifies the diversion based on surveillance activities
Risk Rounding

16. Blood Borne Pathogen Testing
Develop a process with Occupational/Employee Health
BBP testing offered to those suspected of diversion
Should include HIV, Hepatitis ABC, other pathogens suggested by exposure history
Prioritize BBP testing over confession
Testing of victims is usually driven by proven or
suspected infection in the perpetrator

17. Surveillance Monitor patients for Blood Borne Pathogens
Consider the possibility with unexpected or unusual clusters of infections
Determine your criteria, threshold and who the information will be taken to

20. Risk Rounding
This is already a part of our practice in Environment of Care Tours and daily rounding
Know what to look for:
- Tampered seals: caps glued or taped back on, missing tamper seals, lower than expected level of drugs
- Laundry finding syringes hidden in a linen cart
- Needles left in scrub pocket
- Sharps container stored in ceiling tile

21. Immediate Steps for Tampering
Preserve suspicious vials- it is evidence
Photograph the scene before disturbing it, if possible
Maintain chain of custody
Inspect all other medications in the drawer/area
Don’t assume it was done by clinical staff
Call in the ‘army’

22. Suspicious Behaviors Sometimes there are none!
Numerous job changes or work as a traveler
Being in or looking in places they shouldn’t be e.g. Anesthesia carts
Often high achievers and very active is work
Well liked by peers and medical staff
Work the night shift in critical care or other high acuity area
Comes in early, stays late or volunteers for overtime or works when not scheduled

23. The DOH called! Review your labs for unusual clusters or BBP
Case Review of Patients
Pull in your drug diversion team for a huddle
Don’t have one?
- HR, Pharmacy, Risk, Patient Safety, Admin, Managers Communications, etc

24. AAAAHAHHAGGHGHGHGHG! We have an Event!!!!
Set up a command center
You will not be able to handle this alone!
Call the state HAI Coordinator
For large scale events, set up a dedicated call center and have a plan for handling volume increase for testing, notifications, follow up, etc.

25. What Does IP need to do? Find out what your organization is doing
Ensure that Infection Prevention is in the loop!
Make sure policy is in place and up to date
Develop a plan for how to handle exposed patients
Utilize current practices to monitor for these events

26. Questions?