BACKGROUND: Drug diversion by health care workers (HCWs) puts patients at risk for blood borne pathogens (BBPs). Six US outbreaks secondary to HCW drug diversion have been reported since 2004. The opioid epidemic may accelerate incidence; HCWs are more likely to abuse prescription drugs than the general population. Drug diversion investigations can be expensive for public health departments due to extensive staff time to determine patient risk and track patient notifications and test results. In January 2016, the Colorado Department of Public Health and Environment (CDPHE) received a report of a surgical technician diverting fentanyl, putting ~3,000 patients at risk. We report a cost analysis of the public health response which included investigation and patient notification.
METHODS: Personnel time for the CDPHE response was determined by reviewing archived documents and conducting interviews with staff, and included all staff time associated with the investigation and response. Hospital time and costs, including cost of hospital staff time, patient notifications, patient testing, and responding to public and patient questions, were not included. Time was broken down into categories for each part of the investigation and hours of staff time were converted to cost based on staff salaries and overhead costs.
RESULTS: CDPHE’s response required 24 employees from disease control, legal, communications, and emergency preparedness for a total of 1,026 hours of staff time. The investigation included interviewing the HCW and co-workers, determining risk to patients, providing testing recommendations for notified patients, coordinating with the hospital, and managing test result data. Extensive subject matter expertise from CDPHE leadership was also required. The estimated cost for the CDPHE response was $74,480. The breakdown was as follows: $6,643 for the investigation to assess patient risk, $16,216 for coordination with the hospital, $13,758 for monitoring and analysis of patient test results, $15,891 for leadership involvement, $7,364 for media, legal, and emergency preparedness involvement, and $14,608 for overhead costs.
CONCLUSIONS: A public health investigation following a possible BBP exposure due to HCW drug diversion is cost-intensive. When a patient notification is required based on risk assessment, this also increases cost to public health, even when the healthcare facility conducts the patient notification and testing. Given the extensive costs required for drug diversion investigations, efforts should be directed toward prevention.