Shoddy medical practices cause hepatitis B outbreaks at nursing homes, again

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

Source: http://www.ncbi.nlm.nih.gov/pubmed/23739075

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.

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