Practice Makes Imperfect: Investigation of Medical Assistant Students Reporting Health Effects from Practice Injections with a Demonstration Product, Alaska – 2014

BACKGROUND:   In March 2014, the Alaska Section of Epidemiology was notified by students in a medical assistant program who reported health concerns following practice injections with a non-sterile saline solution not intended for use on humans or animals. Injection simulation or demonstration products are intended for use on mannequins but have been mistakenly used on patients in health care settings. One reason for inadvertent use is very similar packaging between actual and simulation products. We present the results of an investigation of students who received these injections in Alaska, and recommendations to prevent this circumstance in the future.

METHODS:   The Section of Epidemiology obtained class lists for the program and attempted to interview all students to document the nature and frequency of injections, and any reported health effects. Epidemiology consulted with the technical college responsible for program oversight to determine how the product came to be used in the classroom. Limited testing of the solution was conducted at a commercial laboratory at the request of the college.

RESULTS:   The demonstration solution was used over two semesters and potentially impacted 31 students; of those, only 11 (35%) agreed to be interviewed. Students reported a median of 26 injections given intradermally, subcutaneously, or intramuscularly. No violations of the bloodborne pathogen standards were reported. Proper needle/syringe use and disposal was reported. Students reported that most health effects, such as pain, itching, or burning, occurred shortly following the injections. Some more systemic or vague symptoms, such as lymphadenopathy or chest pain, were also reported. Microbiologic testing of the solution did not demonstrate any inherently pathogenic bacteria; chemical analysis was not performed. Although the students reported side effects and the improper use of the solution to their instructor many months before Epidemiology was contacted, corrective action was not immediately taken. Epidemiology reported this incident to CDC and the Institute for Safe Medication Practices (ISMP). ISMP included an alert about demonstration solutions in their April 2014 newsletter.

CONCLUSIONS:   Practice injections are common in the medical training profession. In this incident, two classes of students experienced repeated injections with a product not intended for human use. This particular incident in Alaska could have been remedied much faster by the instructor, suggesting that the program had suboptimal curriculum oversight and avenues for addressing student complaints. Additionally, other incidents with simulation products have occurred nationally suggesting a need for improved oversight of these products in general.