OBJECTIVES To summarize patient notifications resulting from unsafe injection practices by health care personnel in the United States and describe recommended actions for prevention and response. PATIENTS AND METHODS We examined records of events involving communications to groups of patients, conducted from January 1, 2012, through December 31, 2018, in which bloodborne pathogen testing was recommended or offered because of potential exposure to unsafe injection practices by health care personnel in the United States. Information compiled included: health care setting(s), type of unsafe injection practice(s), number of patients notified, number of outbreak-associated infections, and whether evidence suggesting bloodborne pathogen transmission prompted the notification. We compared these numbers with a similar review conducted from January 1, 2001, through December 31, 2011. RESULTS From 2012 through 2018, more than 66,748 patients were notified as part of 38 patient notification events. Twenty-one involved exposures in non-hospital settings. Twenty-five involved syringe and/or needle reuse in the context of routine patient care; 11 involved drug tampering by a health care provider. The majority of events (n=25) were prompted by identification of unsafe injection practices alone, absent any documented infections at the time of notification. Outbreak-associated hepatitis B virus and/or hepatitis C virus infections were documented for 11 of the events; 8 involved patient-to-patient transmission, and 3 involved provider-to-patient transmission. CONCLUSIONS Since 2001, nearly 200,000 patients in the United States were notified about potential exposure to blood-contaminated medications or injection equipment. Facility leadership has an obligation to ensure adherence to safe injection practices and to respond properly if unsafe injection practices are identified.

中文翻译：

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因医疗保健人员重复使用注射器和注射药物处理不当而导致的患者通知事件 - 美国，2012-2018 年：预防和应对措施总结和建议。


目的 总结美国医疗保健人员不安全注射行为导致的患者通知，并描述建议的预防和应对措施。患者和方法 我们检查了 2012 年 1 月 1 日至 2018 年 12 月 31 日期间与患者群体进行交流的事件记录，其中建议或提供血源性病原体检测，因为卫生保健人员可能会接触到不安全的注射做法。美国。汇编的信息包括：医疗保健环境、不安全注射做法的类型、收到通知的患者数量、与疫情相关的感染数量，以及表明血源性病原体传播的证据是否促使发出通知。我们将这些数字与 2001 年 1 月 1 日至 2011 年 12 月 31 日期间进行的类似审查进行了比较。 结果 从 2012 年到 2018 年，作为 38 起患者通知事件的一部分，超过 66,748 名患者收到了通知。二十一次涉及非医院环境中的暴露。 25 项涉及在常规患者护理中重复使用注射器和/或针头； 11 起涉及医疗保健提供者篡改药物。大多数事件 (n = 25) 是仅因识别不安全注射行为而引发的，在通知时没有任何记录的感染。其中 11 起事件记录了与暴发相关的乙型肝炎病毒和/或丙型肝炎病毒感染； 8 起涉及患者到患者的传播，3 起涉及医疗服务提供者到患者的传播。结论 自 2001 年以来，美国近 200,000 名患者被告知可能接触受血液污染的药物或注射设备。 设施领导层有义务确保遵守安全注射做法，并在发现不安全注射做法时做出适当反应。