A hospital nurse murdered three patients and poisoned 18 more at Stepping Hill hospital in Stockport, a court has heard.
Victorino Chua, 49, is accused of contaminating saline bags and ampoules with insulin and deliberately altering the dosages on prescription charts.
Tracey Arden, 44, Arnold Lancaster, aged 71, and Derek Weaver, 83, all died as a result of his "handiwork", it is alleged.
The prosecution told jurors at Manchester Crown Court that a "pattern" became clear after a massive police investigation.
"The pieces of the forensic jigsaw began to emerge," said Peter Wright QC.
"The person responsible for each of these matters became increasingly clear. It was, we say, Victorino Chua.
"As the investigation intensified, the common denominator, the defendant, was shown in sharper and sharper relief."
The court heard it was a "lottery" which patients were harmed, with other doctors and nurses unsuspectingly using the contaminated medicines.
Chua, originally from the Philippines, had worked at Stepping Hill since 2009. He first came to the UK in 2002.
All the offences are said to have happened between June 2011 and January 2012.
Chua has pleaded not guilty to 36 charges in total, including three alleged murders, one count of grievous bodily harm with intent, and 23 counts of attempted grievous bodily harm.
He is also facing eight counts of attempting to cause a poison to be administered and one count of administering a poison.
The trial continues.
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