Abstract
In July 2007, two residents of a nursing home were diagnosed with acute Hepatitis B virus infection. To identify risk factors for HBV infection a retrospective cohort study among residents was performed. Case finding included discharged diabetes patients and those receiving home care. Among 32 residents one case of chronic hepatitis B was found that could be identified by genotyping as the source patient for the acute cases. Diabetes and finger sticks were risk factors for HBV infection. Most likely the cause of transmission was a multiclix finger stick device developed for use in individual patients but used in multiple patients. Education and training in the use of new equipment and hygiene audits remain the cornerstones in infection control practices.
Highlights
Hepatitis B virus (HBV) is transmitted by percutaneous and permucosal exposure to infected blood or body fluids, either directly or indirectly through contact with contaminated surfaces
Because finger sticks were suspected to be the cause of transmission, we investigated six out of 42 discharged residents with diabetes mellitus and another eight patients on whom the mobile team had performed finger sticks at home, supposedly with devices from the nursing home
Two concurrent acute hepatitis B infections in people that had lived in the same nursing for more than six months was suggestive of nosocomial transmission
Summary
Hepatitis B virus (HBV) is transmitted by percutaneous and permucosal exposure to infected blood or body fluids, either directly or indirectly through contact with contaminated surfaces. Nosocomial transmission of HBV has previously been associated with unsafe injection practices, including contamination of multidose-multipatient vials and finger stick blood sampling devices with reusable components [1,2,3,4,5,6,7]. Our hypothesis was that HBV transmission had occurred through unhygienic capillary blood sampling. We considered this event a multiple needle stick injury with possible transmission of HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV). To identify exposures associated with HBV infection, a retrospective cohort study was conducted among nursing home residents who lived in the home between 1 January and 31 July, 2007
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