Researchers, writing in the journal of Infection Control and Hospital Epidemiology detail how hepatitis B
outbreaks occurred in two long-term care facilities.
—Christine. M. Kukka, Project Manager, HBV Advocate
Abstract: Acute
hepatitis B outbreaks in two skilled nursing
facilities and possible sources of transmission: North Carolina, 2009-2010.
Seña
AC,
Moorman
A,
Njord
L,
Williams
RE,
Colborn
J,
Khudyakov
Y,
Drobenuic
J,
Xia
GL,
Wood
H,
Moore
Z. Durham County Department of Public Health, Durham, North Carolina.
Objective:
Acute hepatitis B virus (HBV)
infections have been reported in long-term care facilities (LTCFs), primarily
associated with infection control breaks during assisted blood glucose
monitoring. We investigated HBV outbreaks that occurred in separate factors
skilled nursing facilities (SNFs) to determine Outbreak investigation with associated
with transmission.
Design:
Two SNFs (facilities A and B) in Durham, North Carolina,
case-control studies.
Setting:
Residents with acute during 2009-2010. Patients. HBV
infection and controls randomly selected from residents during the outbreak
period. HBV-susceptible After initial cases were Methods. identified, screening
was offered to all residents, with repeat testing 3 months later for
HBV-susceptible residents. Molecular testing was performed to assess viral
relatedness. Infection control practices were between observed. Case-control
studies were conducted to evaluate associations six exposures and acute HBV
infection in each facility.
Results:
Acute HBV cases were identified in each SNF. Viral
phylogenetic analysis revealed a high degree of HBV relatedness within, but not
between, facilities. No evaluated exposures were significantly associated with
acute HBV infection in facility A; those associated with infection in facility
B (all odds ratios >20) included injections, hospital or emergency room
visits, and daily blood glucose monitoring. Observations revealed absence of
trained infection control staff at monitoring facility A and suboptimal hand
hygiene practices during blood glucose insulin injections at facility B.
Conclusions:
Outbreaks underscore the vulnerability of LTCF residents to
acute HBV infection, the importance of surveillance and prompt investigation of
incident cases, and the need for improved infection control education to
prevent transmission.
2013 Jul;34(7):709-16. doi: 10.1086/670996.
Labels: acute HBV, blood glucose monitoring, outbreaks, transmission and prevention