Wednesday, July 8, 2009

Bad scrub.

Cross posted from The Weekend Scrub.

So I've been following this story and giving it some thought.

Short synopsis: A hep C positive scrub in Denver was caught exchanging her dirty syringes filled with saline for fentanyl syringes, which she then shot up with. Thousands of people may have been exposed. After being fired from the Denver hospital she went to work at a one day surgery center where she worked until she was arrested. Hundreds of more potential exposures.

Some interesting tidbits: the hospital knew she was Hepatitis C positive, it showed up on her blood work when she was hired. They counseled her on a ways to avoid avoid exposing patients. A few news stories have made statements that she did not have patient contact. That can't be true, if she was in fact working as a scrub, unless reaching into a patient's abdomen and holding their intestines doesn't count as patient contact.

Also the news stories say that she was caught after being found in an OR which she was not assigned to. This is interesting, as, at every hospital I have worked at, people go into other rooms all the time to steal supplies or say hello to friends. The hospital must have had serious suspicions about her, or she was found messing with the anesthesia stuff. Some of the articles mention a previous drug test which came back negative, so the hospital was probably suspicious.

The fact that she was going into other ORs explains those high numbers of potential exposures. She only worked at the hospital for about six months, so that's about 130 working days. She would have had to have been stealing dozens of syringes a day to actually expose thousands of people. In fact the hospital is testing every one who had surgery at the hospital when she was at work. Of those "only" a hundred or so will be at serious risk of exposure. Pretty horrific, but not quite as scary as the headlines.

I'm still flabbergasted at the substitution of her dirty syringes. Why? Stealing drugs I can understand, that's what addicts do. But exposing people? Surgery departments are awash with syringes. Finding sterile syringes would be quick and easy. Sterile saline is likewise easy to find. I can think of only three reasons why she reuse her dirty syringes: She was paranoid that the extra syringes would be missed; second, she didn't have access to the proper labels for the syringes, or the original labels could not be removed from the original syringe. Not having a proper label on her replacement syringe would expose her quickly. Finally she may have been an evil bitch who wanted to infect other people.

My final thought is that, without taking away any of her responsibility, there are others who have seriously screwed up here. There is no way that she should have been able to go get Fentanyl syringes. Narcotics are suppose to be strictly controlled. Ideally, an anesthesia provider should never draw up a narcotic until he or she is ready to give it. What was obviously happening was that anesthesia was pulling up drugs, setting them down, and leaving the room. Stupid. Especially, as seems likely, there was a staff person about whom the hospital had suspicions of drug abuse.

General badness all around.