Opioid diversion led to an outbreak of Serratia marcescens at a Wisconsin hospital, researchers have found.

Five patients admitted to five different wards at UW Health’s University Hospital in Madison, Wisconsin, were diagnosed with the same strain of bacterial infection in 2014, and epidemiologists have tied that outbreak to syringes that a nurse tampered with to divert the narcotics, according to a study published in Infection Control and Hospital Epidemiology. Four of the infection patients recovered, but one died from a Serratia sepsis infection.

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The researchers found that the nurse had replaced the narcotics in the syringes with saline, likely causing the infections. The nurse was fired, and no further S. marcescens cases have been reported, according to the study.

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