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MRSA Outbreaks Tied to Reuse of Single-Dose Vial Injections

July 13, 2012 — In this week’s issue of Morbidity and Mortality Weekly Report, the Center for Disease Control (CDC) has announced that two outbreaks of invasive, drug-resistant Staphylococcus aureus (MRSA) occurred because health care professionals improperly used single-dose vials of pain medicine on more than one patient. Since 2007, there have been 20 outbreaks of MRSA associated with re-use of single-dose vials for multiple patients. Most of the outbreaks occurred because of drug shortages in smaller-vial sizes, which forced professionals to use larger vials on multiple people.

The first outbreak of MRSA occurred at an orthopedic clinic in Delaware in March 2012. The Delaware Department of Health and Social Services was notified that seven patients were admitted to the hospital with MRSA infections in their knee, hip, or thumb. The patients required surgery to remove infected tissues. All seven patients had received injections from the same orthopedic clinic.

An investigation revealed that the clinic had reused single-dose vials of an anesthetic on multiple patients, when a national drug shortage disrupted supplies of 10 mL single-dose vials of the drug. The clinic was forced to use 30 mL vials on multiple patients, each vial accessed multiple times during the day and sometimes stored until the next day. Two staff members responsible for preparing injections tested positive for MRSA, including the strain that infected that patients.

The Department of Public Health re-trained staff on safe injection practices and issued an alert to the medical community.

The second MRSA outbreak investigation began in April 2012, when the Arizona Department of Health Services were notified that several people had contracted methicillin-resistant MRSA after being treated at the same outpatient pain management clinic. Investigators found that nurses took single-dose vials of medicine and transferred the contents to alternate vials, resulting in diluted, cross-contaminated solutions.

Three patients were hospitalized with a MRSA infection 4-8 days after being treated at the clinic. The patients suffered from severe infections, including bacterial meningitis, epidural abscess, and sepsis. The duration of their hospital stay varied from 9 to 41 days. One patient required additional long-term care. A fourth patient was found deceased at home, and it is possible that MRSA contributed to the death.

It is unknown how MRSA contaminated the vials. However, health officials noted that personnel failed to wear face masks during spinal injections.

MRSA stands for “methicillin-resistant Staphylococcus aureus,” and it causes a disease that cannot be cured with first-line antibiotic treatments. Once the infection begins, it can quickly spread to the bones, joints, blood, or vital organs. MRSA infections tend to be very severe and difficult to treat. People who have weakened immune systems are most susceptible to a life-threatening MRSA infection. Sometimes, MRSA “colonizes” people without causing severe infection (this is especially common among health care workers). People who are colonized with MRSA can easily spread the bacteria to other people with skin-to-skin contact.

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