Posted on 04/10/2014 7:38:45 PM PDT by Jet Jaguar
FAIRBANKS — The University of Alaska Fairbanks is launching a widespread review of its procedures after dozens of students in the medical assistant program were told to inject each other with a solution that isn’t approved for human or animal use.
Students practiced their injection techniques with the unauthorized solution during each of the past two semesters, according to UAF.
Students only confirmed the potential danger after one of them contacted the manufacturer and was told to stop using the product immediately. Chancellor Brian Rogers called it “the most serious issue I’ve seen” since taking the top position at UAF in 2008.
“It should not have happened — I’m heartsick over it,” he said. “I’ve lost more sleep over this than any other issue in my six years as chancellor.”
Rogers said UAF accepts responsibility for the improper use of the solution, which is a Demo Dose product called “Simulated 0.9 percent Sodim Chlorde Injection” and whose label states that it shouldn’t be used on humans or animals. Students typically would use a sterile saline or water solution to practice their injections and use the Demo Dose product — “Sodim Chlorde” is the spelling listed on the product — only for injection pads or training devices.
Despite the warning, an instructor in two UAF Community and Technical College classes this year had students repeatedly inject each other with the solution. Students complained of burning sensations immediately following the injections and some also experienced skin irritation.
Rogers said that no health problems have been definitively linked to the injections but that UAF is still reviewing their effects.
UAF officials believe a total of about 30 students received improper injections during the past two semesters. A small number of injections occurred during the Clinical Procedures I class during the fall semester, but most took place in two Clinical Procedures II classes this school year, where students were told to use the solution to improve their injection skills.
It’s unclear how many cumulative injections students received. Classroom logs indicate that the average student got about 10 total injections, but those records may be incomplete, said CTC Dean Michele Stalder.
The instructor who taught the classes, term assistant professor Sherry Wolf of the Allied Health Department, has been placed on paid investigatory leave while the situation is reviewed. Stalder said Wolf, whose contract expires at the end of the school year, won’t have her contract renewed.
A broader review of the Allied Health Department is also being conducted. Rogers said the student complaints about the solution were made to a department administrator on Feb. 24 and should have been “reported up” to risk management and other UAF officials but that those contacts weren’t made. No other UAF employees have faced any personnel action so far, Rogers said.
UAF administrators said they only learned of the issue after Pocket Nurse, the Pennsylvania-based manufacturer of the solution, sent a March 6 letter responding to a student phone call that the product was being used during injection practice. The company had received “an alarming call” detailing the use of the solution on classmates, according to the letter.
Pocket Nurse President Anthony Battaglia stated in the letter that the company’s products “are clearly labeled on their labels, packaging and any documentation that the products are NOT to be used on human beings or animals.” The letter instructs UAF to stop misusing the products and get medical attention for the affected students.
Rogers said UAF is using an independent lab to determine whether the solution contains harmful substances. Preliminary tests have shown bacteria strains in at least some of the vials — Aeromonas hydrophila and bacteria from the genus Brevundimonas. One strain commonly causes a rash, while the other isn’t known to cause disease in humans.
The injections also included a 0.5 percent solution of the toxin isopropyl alcohol, which reportedly explains the burning sensation students reported. Rogers said other possible contaminants are still being sought and that UAF has agreed to pay for medical testing for those students affected.
“The students have reported other symptoms that we can’t explain at this point,” he said.
Rogers said final lab results, which will looking for a broad spectrum of bacterial and fungal agents, should be available by the end of the week. UAF believes that the improper use of the solution is limited to the past two semesters, based on procurement records from previous years. But it is conducting an analysis of its procurement procedures to be certain, and letters are also being mailed to summarize the injection problems to Wolf’s previous students, even those who aren’t known to be affected. Wolf began teaching at UAF as an adjunct professor in 2006, before being promoted to term assistant professor in 2009.
UAF officials have had several meetings with students in this semester’s class during the past month to provide testing updates. Stalder began contacting Wolf’s fall semester students on Monday to explain the situation.
Rogers said UAF officials were waiting for definitive test results before notifying past students but were spurred to act sooner after receiving a media question about the injections.
“It’s been a challenge,” Rogers said. “How do we provide the best information we have and not jump the gun?”
The issue also has caused academic concerns for some students, whose studies have been sidetracked by the issue in the past month. Rogers said the students pursuing medical assistant certificates or associate degrees are being offered tutors and make-up sessions.
In the wake of the controversy, Rogers and Stalder have launched a broad review of UAF procedures, including how incidents are reported, policies for responding to complaints, and procurement practices. University of Alaska Fairbanks President Pat Gamble has also requested a review of operations at UAF’s health programs.
Rogers said many questions, both regarding the injections and how they were allowed to happen, remain unanswered. He said he’s hopeful the picture will become clearer in the months ahead.
“At this point, we don’t know what we don’t know,” Rogers said.
Title too long.
UAF reviews medical assistant program procedures after students inject unauthorized solution in classmates
That'll teach her!!
Those who can't do ... teach.
Stupid in = stupid out. (But I'll bet they met all their quotas when they put that faculty together.)
Why do they manufacture a solution called that if you aren’t supposed to use it ??
What's the big whoop?
Sounds like water with sodium chloride in it. In other words, just basic saline solution, which would be the logical thing to use to practice injections.
Evidently the Chinese label-maker can’t spell English very well. And Chinese products need to be checked out to be sure they haven’t screwed something up with pollutants.
Maybe they should just check this stuff out, and see if it’s really saline solution? And if so, the right percentage of salt, and no impurities? I should think a large university would have someone who could do such simple tests, or send it to someone who can.
Really a bunch of dumb mistakes piled atop one another. For one, even having a product on hand labeled "Sodim Chlorde" is unbelievably stupid, in my opinion.
Probably just doing what they were told, but one shouldn't ignore a label that says, "not for human use." Perhaps the instructors didn't do a very good job teaching the students to ALWAYS double-check all medications before each and every administration.
They would be nuts to practice injections with sterile water as well. I’m not sure why the article suggests it is acceptable.
So, what, was this Ms. Wolf person offering a real-world hands-on demonstration of the effects of septicemia? Or was this a demonstration on embolisms and emergency toxicology?
I’m happy that some students at least looked into the matter, but seriously, how screwed up is the program, the school, and the student body for this to have continued for two semesters?
What’s worse is everyone up the chain of the command promptly “forgot” or “lost the paperwork” until the company making the solution found out about it and started making a scene.
How many brain cells does it take to realize that it’s a bad idea to go about injecting yourself or your students with something labeled “Sodim Chlorde - NOT FOR HUMAN OR ANIMAL USE!!!” ??
Obamacare ‘doctors’ in training.
When I was in nursing school (back in the dark ages), we practiced injections by shooting the solution into an orange or a grapefruit-—then destroyed the fruit that had been injected………...
If it's sterile, it's not going to hurt anyone. The human body is full of water.
Normal sterile saline more closely approximates the osmolarity of blood, and it's relatively cheap, which is why it's frequently used for volume replenishment. Apparently not cheaper than "Sodim Chlorde," however!
Water is hypotonic and can cause localized tissue damage, particularly if injected into a vessel or nerve.
“Why do they manufacture a solution called that if you aren’t supposed to use it ?”
It’s called “Sodim Chlorde” because Sodium Chloride is a real thing, and the manufacturers were trying to be painfully obvious that this wasn’t that thing. Hence the additional label “NOT FOR HUMAN OR ANIMAL USE!”.
However, simulated substances are necessary for use on training dummies, simulated injection pads (basically rubber and latex that is meant to ‘feel’ like real tissue does when you poke a needle into it) and the like. In this case injecting latex pads or rubber dummies with products meant for human use would be incredibly expensive and pointless (and might even accelerate wear on the training aids). So, you buy cheap, latex-friendly non-sterile simulated substances clearly labeled as not for human or animal use.
As an example of a similar situation, when learning how to perform an endotracheal intubation it can be a real pain to get a plastic tube shoved down a rubber dummy’s simulated trachea. So, sometimes, things like PAM cooking spray, lithium grease, or similar are used to grease the medical apparatus. This is fine, as the “patient” in this case is a fake rubber head and torso.
However, if you tried to shove a plastic tube into a human’s lungs with PAM or lithium grease then you might kill the poor sod. On the bright side though, there’s a community college in Alaska willing to hire just the kind of person that would do that.
“Sounds like water with sodium chloride in it. In other words, just basic saline solution, which would be the logical thing to use to practice injections.”
Apparently your participation in the grand and glorious Free Republic tradition of not reading the article means you missed the part where it said the solution contained isopropyl alcohol and was also found to be contaminated with more than one strain of bacteria.
Lol
“Water is hypotonic and can cause localized tissue damage, particularly if injected into a vessel or nerve.”
Dang, I forgot to add various forms of necrosis to my list of fun hands-on classroom demonstrations this program was trying to achieve.
Step 1 should be for each of the students to inject 10 syringes of it into the course instructor. If she evidences no ill effects, no need to go to step 2.
Eye for an eye.
Works for me.
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