Bloodborne pathogens

[nimbus]

Happens every few years. Probably reusing syringes on different patients. Why do people do this? We all pay by being forced to repeatedly watch mandatory infection prevention videos.

https://www.koin.com/news/portland/providence-possible-hiv-hepatitis-infections-07112024/

---

Members don't see this ad.

 

[GassYous]

Why would you reuse a syringe on different patients

I'd rather see someone use 10 syringes for one case

 

[sevoflurane]

Unbelievable this still happens after the Vegas fiasco. Makes physicians look bad- should have his license revoked or at least put on probation.
If I take over a room and find prefilled propofol in a syringe or any labeled drug in a syringe, it immediately goes into the trash.

 

[nimbus]

Unbelievable this still happens after the Vegas fiasco. Makes physicians look bad- should have his license revoked or at least put on probation.
If I take over a room and find prefilled propofol in a syringe or any labeled drug in a syringe, it immediately goes into the trash.

The Vegas incident occurred at a physician owned endoscopy center. They might have been trying to save money by reusing syringes. In this case, the anesthesiologist was likely reusing hospital supplied syringes.

 

[Dr. Rude]

 

[abolt18]

Unbelievable this still happens after the Vegas fiasco. Makes physicians look bad- should have his license revoked or at least put on probation.
If I take over a room and find prefilled propofol in a syringe or any labeled drug in a syringe, it immediately goes into the trash.

Amen. 100% trash every time, unless I watched the syringe opened and drug drawn up.

 

[sevoflurane]

The Vegas incident occurred at a physician owned endoscopy center. They might have been trying to save money by reusing syringes. In this case, the anesthesiologist was likely reusing hospital supplied syringes.

Never understood that. We are not a 4th world country. What did it save? $3 a day?
Geesh. Smart (supposedly) physician making really dumb decisions.
Endo surgery centers are cash cows for the owners.

 

[Dr. Rude]

Never understood that. We are not a 4th world country. What did it save? $3 a day?
Geesh. Smart (supposedly) physician making really dumb decisions.
Endo surgery centers are cash cows for the owners.

some combination of laziness, perception of saving a few bucks, coupled with a total disregard for their patients.

 

[VA Hopeful Dr]

Never understood that. We are not a 4th world country. What did it save? $3 a day?
Geesh. Smart (supposedly) physician making really dumb decisions.
Endo surgery centers are cash cows for the owners.

Without knowing exactly what size syringes/needles are typically used in anesthesia I can't definitively say.

10cc luer lock syringes run around 8-10 cents each, 18g luer lock needles run about the same. Smaller ones of both cost less, larger cost more. Make of that what you will

 

[UscGhost]

Do we know if it was actually reusing syringes or reusing a multi dose vial? Some hospitals don't allow multi dose vials to be used on multiple patients (so they can bill multiple patients) or perhaps he was splitting a non-multiple dose vial.

For example, dividing up a 100ml propofol bottle across 3 GI cases, if drawn up in sterile fashion, isn't exactly putting patients at risk but may be violating hospital protocol

 

[nimbus]

Similar case. Guy started practice before institution of universal precautions. Was reusing syringes for decades before an anesthesia tech noticed and spoke up.

https://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5CDIDOCS%5C20210323%5CDMRAAAHL4%5C&did=AAAHL210323205716769.DID

Kaiser Cuts Ties with Doctor for Allegedly Reusing Syringes | San Jose Inside

Hospital officials said Kaiser cut ties with anesthesiologist David Reese Rummell on Sept. 30 after reporting him to state authorities.

www.sanjoseinside.com

 

[deleted1183938]

Amen. 100% trash every time, unless I watched the syringe opened and drug drawn up.

Do you work with CRNAs??

 

[deleted1183938]

Unbelievable this still happens after the Vegas fiasco. Makes physicians look bad- should have his license revoked or at least put on probation.
If I take over a room and find prefilled propofol in a syringe or any labeled drug in a syringe, it immediately goes into the trash.

I work with CRNAs and they draw up their drugs, label and give them to me to push. So far so good. I can’t do it all.

 

[deleted1183938]

Similar case. Guy started practice before institution of universal precautions. Was reusing syringes for decades before an anesthesia tech noticed and spoke up.

https://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5CDIDOCS%5C20210323%5CDMRAAAHL4%5C&did=AAAHL210323205716769.DID

Kaiser Cuts Ties with Doctor for Allegedly Reusing Syringes | San Jose Inside

Hospital officials said Kaiser cut ties with anesthesiologist David Reese Rummell on Sept. 30 after reporting him to state authorities.

www.sanjoseinside.com

No way he practiced before universal precautions. When were universal precautions implemented??
This is just an egotistical dingus acting like everyone else is just dumb compared to him. He knew and just wanted to prove a point.

 

[nimbus]

No way he practiced before universal precautions. When were universal precautions implemented??
This is just an egotistical dingus acting like everyone else is just dumb compared to him. He knew and just wanted to prove a point.

I could be mistaken but I think universal precautions were adopted with the emergence of AIDS in the mid to late 1980s. This doctor was initially licensed in 1977. When I was in training, multi dose vials were still commonly reused. And a lot of old timers were still doing IVs and Alines with bare hands.

 

[PpfSuxTube]

Surely no way they were reusing syringes. More likely splitting vials

 

[maxxor]

I could be mistaken but I think universal precautions were adopted with the emergence of AIDS in the mid to late 1980s. This doctor was initially licensed in 1977. When I was in training, multi dose vials were still commonly reused. And a lot of old timers were still doing IVs and Alines with bare hands.

Appendix A: Table 1. History of Guidelines for Isolation Precautions in Hospitals

Appendix A of Isolation Precautions: Table 1. History of Isolation Guidelines

www.cdc.gov

CDC - based on their timeline 1985 is the earliest year for universal precautions.

 

[nimbus]

Do we know if it was actually reusing syringes or reusing a multi dose vial? Some hospitals don't allow multi dose vials to be used on multiple patients (so they can bill multiple patients) or perhaps he was splitting a non-multiple dose vial.

For example, dividing up a 100ml propofol bottle across 3 GI cases, if drawn up in sterile fashion, isn't exactly putting patients at risk but may be violating hospital protocol

Hope that was the case. Will find out as more details are revealed.

 

[deleted1183938]

I could be mistaken but I think universal precautions were adopted with the emergence of AIDS in the mid to late 1980s. This doctor was initially licensed in 1977. When I was in training, multi dose vials were still commonly reused. And a lot of old timers were still doing IVs and Alines with bare hands.

Alright. Thanks for the edumacation on that. We can all agree that he knew better though. Jerk.

 

[sevoflurane]

I work with CRNAs and they draw up their drugs, label and give them to me to push. So far so good. I can’t do it all.

?

My point is if I find a syringe in a drawer or left out somewhere it goes in the trash.

Completely different if a partner hands them to me and declares them to belong to the patient I am taking care of.

 

[deleted1183938]

?

My point is if I find a syringe in a drawer or left out somewhere it goes in the trash.

Completely different if a partner hands them to me and declares them to belong to the patient I am taking care of.

Sorry. Misunderstood. Some people trust no one.

 

[PpfSuxTube]

Sorry. Misunderstood. Some people trust no one.

Yeah I got colleagues that will throw out every syringe or drawn up medication they didn't personally draw up themselves...

I'm not talking random syringes either.

I mean syringes handed to them by colleagues specifically for this patient. They will throw every single one in the trash right in front of our colleagues face... it's wierd bordering obnoxious.

We have to trust our colleagues to do their job by in large... do I question every CT or tte done by other depts?

Yes ha ha

 

[Beeftenderloin]

Yeah I got colleagues that will throw out every syringe or drawn up medication they didn't personally draw up themselves...

I'm not talking random syringes either.

I mean syringes handed to them by colleagues specifically for this patient. They will throw every single one in the trash right in front of our colleagues face... it's wierd bordering obnoxious.

We have to trust our colleagues to do their job by in large... do I question every CT or tte done by other depts?

Yes ha ha

Not to derail the thread, but I stopped trusting most echos read by cardiology. Once I learned that they routinely under-call things because if it was appropriately labeled they would have to “do something about it” I stopped trusting them. Severe range stuff I trust. But anything labeled mild or moderate I assume is under called, as a rule, unless I’ve looked at the images myself. AI, MR, TR and RV size/function being the worst offenders.

 

[Gas you down]

Do we know if it was actually reusing syringes or reusing a multi dose vial? Some hospitals don't allow multi dose vials to be used on multiple patients (so they can bill multiple patients) or perhaps he was splitting a non-multiple dose vial.

For example, dividing up a 100ml propofol bottle across 3 GI cases, if drawn up in sterile fashion, isn't exactly putting patients at risk but may be violating hospital protocol

My question too.
Every hospital I’ve ever worked in has an insulin vial open in a periop area fridge that everyone takes turns drawing doses out of…

 

[PpfSuxTube]

Not to derail the thread, but I stopped trusting most echos read by cardiology. Once I learned that they routinely under-call things because if it was appropriately labeled they would have to “do something about it” I stopped trusting them. Severe range stuff I trust. But anything labeled mild or moderate I assume is under called, as a rule, unless I’ve looked at the images myself. AI, MR, TR and RV size/function being the worst offenders.

Totally agree, I always look at my preop tte images. Forget the reports. Nonsense

One time I did a resternotomy for a chest drain in the RV (long story) most op mv repair. Anyways the repair had fallen apart with severe eccentric jet. I told the surgeon but he was not interested given the timing.

Anyway the post op tte reported only mild Mr. The surgeon laughed at me. So I checked the images. An obvious severe jet was there just slightly out of image... few days later MVR

 

[maxxor]

Not to derail the thread, but I stopped trusting most echos read by cardiology. Once I learned that they routinely under-call things because if it was appropriately labeled they would have to “do something about it” I stopped trusting them. Severe range stuff I trust. But anything labeled mild or moderate I assume is under called, as a rule, unless I’ve looked at the images myself. AI, MR, TR and RV size/function being the worst offenders.

This explains so much! When I’m looking at echo reports as I’m reading stress perfusion or coronary cta, I frequently wonder if I’m looking at the same patient as the cardiologist.

 

[cchoukal]

The CDC has had safe injection practices calling for a “one vial, one syringe, one patient” approach for nearly 15 years. Both the ASA and AANA endorse this policy. Using anything as a multi dose vial, even if the vial says it, is actionable.

 

[deleted1183938]

Yeah I got colleagues that will throw out every syringe or drawn up medication they didn't personally draw up themselves...

I'm not talking random syringes either.

I mean syringes handed to them by colleagues specifically for this patient. They will throw every single one in the trash right in front of our colleagues face... it's wierd bordering obnoxious.

We have to trust our colleagues to do their job by in large... do I question every CT or tte done by other depts?

Yes ha ha

We certainly have to have some level of trust in our colleagues. That is very paranoid.
Imagine if all of us who worked with CRNAs, Residents and CAAs did that.

 

[hiltxan]

No one has any interest in saving vials and equipment, not just for money sake but also reduce waste? There's so much waste in the OR that "one vial, one syringe, one patient" seems overkill. If there is a systematic workflow, does anyone oppose to reuse syringes needles and medications? Just off the top of the head, you can mix versed and fentanyl in the same syringe for induction but technically not allowed by ASA? Or using roc (multidose) and drawing it into 5cc syringes for two cases? If you are solo in the same room you should be able to trust yourself?

 

[cchoukal]

No one has any interest in saving vials and equipment, not just for money sake but also reduce waste? There's so much waste in the OR that "one vial, one syringe, one patient" seems overkill. If there is a systematic workflow, does anyone oppose to reuse syringes needles and medications? Just off the top of the head, you can mix versed and fentanyl in the same syringe for induction but technically not allowed by ASA? Or using roc (multidose) and drawing it into 5cc syringes for two cases? If you are solo in the same room you should be able to trust yourself?

Nope. Not for one second.

 

[abolt18]

No one has any interest in saving vials and equipment, not just for money sake but also reduce waste? There's so much waste in the OR that "one vial, one syringe, one patient" seems overkill. If there is a systematic workflow, does anyone oppose to reuse syringes needles and medications? Just off the top of the head, you can mix versed and fentanyl in the same syringe for induction but technically not allowed by ASA? Or using roc (multidose) and drawing it into 5cc syringes for two cases? If you are solo in the same room you should be able to trust yourself?

I mix my propofol, lidocaine, and Roc all in one syringe. I then use that same syringe to administer my decadron and zofran later. That syringe and needle gets thrown away at the end of the case.

 

[nimbus]

No one has any interest in saving vials and equipment, not just for money sake but also reduce waste? There's so much waste in the OR that "one vial, one syringe, one patient" seems overkill. If there is a systematic workflow, does anyone oppose to reuse syringes needles and medications? Just off the top of the head, you can mix versed and fentanyl in the same syringe for induction but technically not allowed by ASA? Or using roc (multidose) and drawing it into 5cc syringes for two cases? If you are solo in the same room you should be able to trust yourself?

“One patient” is the key. I never reuse anything between 2 patients.

 

[Luv2N2B8]

10cc luer lock syringes run around 8-10 cents each

...if you can get them. This just in, our OR (medium-large metropolitan hospital) is running low.

 

[Luv2N2B8]

“one vial, one syringe, one patient”

That's nice. This logic would work if adequate drug supplies weren't an issue in 2024. So you use a 10-ml succ vial for a 3 mL dose, a 500 mg Brevital vial for a 60 mg dose, and throw those vials out. Repeat x15 cases. Now the pharmacy says they're running out of those.

 

[nimbus]

That's nice. This logic would work if adequate drug supplies weren't an issue in 2024. So you use a 10-ml succ vial for a 3 mL dose, a 500 mg Brevital vial for a 60 mg dose, and throw those vials out. Repeat x15 cases. Now the pharmacy says they're running out of those.

Have the pharmacy divide the vials into single use syringes. Our pharmacy provides ketamine 50mg/1ml in 3ml syringes so we don’t waste 450mg of a 500mg vial if we only need 50mg for a patient. We do this with sugammadex too. Don’t need to crack open an $80 vial of sugammadex if you only need $20 worth of sugammadex.

 

[cchoukal]

That's nice. This logic would work if adequate drug supplies weren't an issue in 2024. So you use a 10-ml succ vial for a 3 mL dose, a 500 mg Brevital vial for a 60 mg dose, and throw those vials out. Repeat x15 cases. Now the pharmacy says they're running out of those.

Honestly, not my problem. I mean it is, in the sense that I want to do cases and get paid, but if pharmacy is telling me I need to violate my own professional society's guidelines, they can eat it.

 

[narcusprince]

Have any of you worked at an ASC before. I worked at an ASC where we had to routinely draw up the Ketamine from a crusty vial. I rarely used it unless I needed to. Too many punctures honestly that ASC was the worst I had seen. In the military we practiced one vial on syringe one patient.

 

[cchoukal]

Have any of you worked at an ASC before. I worked at an ASC where we had to routinely draw up the Ketamine from a crusty vial. I rarely used it unless I needed to. Too many punctures honestly that ASC was the worst I had seen. In the military we practiced one vial on syringe one patient.

Plenty. I just wouldn’t use ketamine if that were the only way to get it. I’m not super dogmatic about much, but I don’t reuse vials. Not ever.

 

[narcotics999]

Have the pharmacy divide the vials into single use syringes. Our pharmacy provides ketamine 50mg/1ml in 3ml syringes so we don’t waste 450mg of a 500mg vial if we only need 50mg for a patient. We do this with sugammadex too. Don’t need to crack open an $80 vial of sugammadex if you only need $20 worth of sugammadex.

You have a nice pharmacy.

I reuse 500mg sugammadex. Always make a new syringe at the time of administering it.

 

[Southpaw]

Have the pharmacy divide the vials into single use syringes. Our pharmacy provides ketamine 50mg/1ml in 3ml syringes so we don’t waste 450mg of a 500mg vial if we only need 50mg for a patient. We do this with sugammadex too. Don’t need to crack open an $80 vial of sugammadex if you only need $20 worth of sugammadex.

Does it matter at all what they charge the patient or what they receive for reimbursement? I don't want to be wasteful and of course I want to be safe, but generally speaking anytime you ask anyone outside of the anesthesia world (esp with regards to pharmacy) don't they generally say one vial one patient (even if labeled multi-dose)?

If your pharmacy is taking a 200mg vial of sugammadex and breaking it down to 50mg/ml syringes, is the hospital charging the patient 1/4 of what they'd charge for a 200mg/vial? I really don't see what occurring based on what we know about hospitals, insurance companies, and how those contracted rates/negotiations go.

I used to be a lot more idealistic and have a desire to conserve medications if we could. Now I feel we should protect ourselves and be safe. One vial one patient. If the pharmacy wants to do what they're doing for you that's great, but I would want to know that the hospital isn't charging patients for the entirety of the vial. In my limited experience, I believe they do.

 

[nimbus]

Does it matter at all what they charge the patient or what they receive for reimbursement? I don't want to be wasteful and of course I want to be safe, but generally speaking anytime you ask anyone outside of the anesthesia world (esp with regards to pharmacy) don't they generally say one vial one patient (even if labeled multi-dose)?

If your pharmacy is taking a 200mg vial of sugammadex and breaking it down to 50mg/ml syringes, is the hospital charging the patient 1/4 of what they'd charge for a 200mg/vial? I really don't see what occurring based on what we know about hospitals, insurance companies, and how those contracted rates/negotiations go.

I used to be a lot more idealistic and have a desire to conserve medications if we could. Now I feel we should protect ourselves and be safe. One vial one patient. If the pharmacy wants to do what they're doing for you that's great, but I would want to know that the hospital isn't charging patients for the entirety of the vial. In my limited experience, I believe they do.

I don’t know what proportion of our patients get charged a la carte vs fixed price for a procedure. A lot of our patients are indigent (homeless or border wall falls) so there’s that.

We asked the pharmacy to divide ketamine because it was inconvenient for us to waste ketamine every single time we opened a vial. Our pharmacy came to us asking if they can divide sugammadex vials as a cost saving measure.

 

[deleted1183938]

That's nice. This logic would work if adequate drug supplies weren't an issue in 2024. So you use a 10-ml succ vial for a 3 mL dose, a 500 mg Brevital vial for a 60 mg dose, and throw those vials out. Repeat x15 cases. Now the pharmacy says they're running out of those.

I will one up you. With the advent of computerized charting for nurses, many places will have them scan a drug. So for PACU let’s say you order 25mcg at a time and the patient ends up getting all 100mcg. Well the nurse will pull out and scan four vials. Because the computer wants a new code each time. So for the same damn patient, nurses are throwing away 75mcg each vial because this is the new system.
What a bunch of crap.

 

[deleted1183938]

I don’t know what proportion of our patients get charged a la carte vs fixed price for a procedure. A lot of our patients are indigent (homeless or border wall falls) so there’s that.

We asked the pharmacy to divide ketamine because it was inconvenient for us to waste ketamine every single time we opened a vial. Our pharmacy came to us asking if they can divide sugammadex vials as a cost saving measure.

Ok at first I thought, Border wall falls?? Was joke. But then I realized this is physically a thing that could happen. So they fall trying to scale the wall right??

 

[nimbus]

Ok at first I thought, Border wall falls?? Was joke. But then I realized this is physically a thing that could happen. So they fall trying to scale the wall right??

They fall after they get over the top. If they fall while climbing and land on the Mexican side, they don’t come to us. Mostly lower extremity injuries, some back injuries. When they were held in Border Patrol custody, Border Patrol used to foot the medical bills. Nowadays they are no longer held in custody so I’m not sure who if anyone is paying. Likely the county is paying part of the bill because they are almost always admitted as trauma activations.

 

[nimbus]

Thousands of possible HIV exposures lead to class action lawsuit against Providence

A class action lawsuit was filed on Friday night in federal court against Providence and the Oregon Anesthesiology Group.

www.kptv.com

 

[TheLoneWolf]

Thousands of possible HIV exposures lead to class action lawsuit against Providence

A class action lawsuit was filed on Friday night in federal court against Providence and the Oregon Anesthesiology Group.

www.kptv.com

A large hospital system I worked at. I keep hearing how the former anesthesia chair was this beloved guy and nurses swoon when they hear the dudes name. Left before I started.

Finally asked around and was told that nurses had caught him on more than 1 occasion using the same propofol syringe on a pump with the same extension tubing on multiple patients. Just hook on and hook off between cases. Current chairman who knows the guy said the dude absolutely could not believe that blood could reflux back through the extension tubing to the syringe or present an infection risk.

Was told by the other partners to quietly leave. He left to the nearest large city where he currently has a cushy academic job where he is covering 2 resident rooms daily. Failed up.

To the best of my knowledge, no investigation was done.

 

[cchoukal]

This is pathological. What is wrong with these people?

 

[GassYous]

A large hospital system I worked at. I keep hearing how the former anesthesia chair was this beloved guy and nurses swoon when they hear the dudes name. Left before I started.

Finally asked around and was told that nurses had caught him on more than 1 occasion using the same propofol syringe on a pump with the same extension tubing on multiple patients. Just hook on and hook off between cases. Current chairman who knows the guy said the dude absolutely could not believe that blood could reflux back through the extension tubing to the syringe or present an infection risk.

Was told by the other partners to quietly leave. He left to the nearest large city where he currently has a cushy academic job where he is covering 2 resident rooms daily. Failed up.

To the best of my knowledge, no investigation was done.

I've seen it back up though?

 

[nimbus]

I've seen it back up though?

Very easy to see reflux with stuff like fluorescein.