Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering. A case for selective drug screening of health care personnel.

Three patients in a university hospital developed nosocomial infusion-related Pseudomonas pickettii bacteremia. Investigation identified six additional patients who had received intravenous fluid contaminated by P pickettii but did not become ill. All nine patients had had surgery, and each of these patients but only nine of 19 operated-on control patients had received intravenous fentanyl citrate in the operating room; the mean dose given to the nine case patients was far greater than that given to control patients. Fentanyl in 20 (40%) of 50 predrawn 30-mL syringes was shown to be contaminated by P pickettii. Contamination was caused by theft of fentanyl from predrawn synringes and replacement by distilled water contaminated by P pickettii. Narcotic theft by health care personnel may cause patients to suffer pain needlessly and can also result in dire unanticipated consequences, such as nosocomial bacteremia. Whereas drug testing in the workplace is highly controversial, we believe that testing of health care personnel is indicated when drug abuse or theft is suspected.

Feasibility of prime vendor purchasing for a state university hospital.

The economic feasibility of implementing a prime vendor purchasing system for pharmaceuticals was evaluated in a midwestern university hospital. Inventory costs, personnel costs, and check processing costs under the current purchasing system were compared with costs estimated for a proposed prime vendor purchasing system. For each step in the purchasing process that would be changed under the proposed system, work measurement techniques were used to determine personnel costs. The total savings from reductions in inventory holding costs, personnel costs, and check processing costs under the proposed prime vendor system was +98,396.37, or 2.4% of the value of pharmaceuticals purchased. Since the pharmacy department could not negotiate a contract in which the prime vendor's service fee was 2.4% or less, implementing a prime vendor purchasing system would not have been cost effective. Therefore, the hospital retained its existing purchasing system. Through detailed analysis of the major costs involved in pharmaceutical purchasing, the hospital was able to determine that it was not cost effective for it to use prime vendor purchasing.