Drug Shortages Lead to Dangerous Clinical Practices

Recent drug shortages of certain injectable medications have led to at least two known disease outbreaks in Arizona and Delaware. The individuals became infected when multiple patients were given injections from a single-patient dosage vial due to the shortage of multi-person dose packages. Ten patients have been hospitalized and one has died as a result of the risky practice.

The problems in Arizona began when a clinic healthcare provider diluted a single-dose vial of contrast agent and used it to inject 10 different patients. The contrast agent, used to make x-rays clearer, became contaminated with the antibiotic resistant MRSA bacteria. Three patients were infected with MRSA, and all of them were hospitalized with meningitis, blood infections or abscesses. A fourth patient was found dead in his home six days after receiving the injection; though his official cause of death was reported to be a multiple-drug overdose, a MRSA infection could not be ruled out.

In Delaware, seven patients were hospitalized after a health-care provider at an orthopedic clinic used a single-dose vial of joint pain medication to inject them all. Two clinic workers were found to be carriers for the bacteria S. aureus and though they were not made ill, they transmitted it to others who were made sick by the bug. All seven patients tested positive for identical S. aureus infections.

According to the Centers for Disease Control's (CDC) investigation of the outbreaks, staff at both clinics reported having trouble getting vials that are designed for multiple uses. Many drugs are experiencing national shortages such as these due to manufacturing problems. The CDC uses statistics from the report to remind health care providers that reusing single dose vials is not the answer to the shortage problem.

"This report reminds health-care providers of the serious consequences of multi-patient use of single-dose vials that can occur even when health-care workers believe they are being careful," the report says. Though there are safe ways to use small vials for several patients, staff must be specially trained in the appropriate methods. Providers should never use single-dose vials to treat more than one patient. If they do, and someone falls ill as a result, they may be held accountable for damages incurred.

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