Acute Hepatitis B Outbreaks Related to Fingerstick Blood Glucose Monitoring in Two Assisted Living Facilities

[Guest guest]

http://www3.interscience.wiley.com/journal/123236683/abstract?CRETRY=1 & SRETRY=0

Journal of the American Geriatrics Society

Early View (Articles online in advance of print)

Published Online: 8 Jan 2010

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

BRIEF REPORTS

Acute Hepatitis B Outbreaks Related to Fingerstick Blood Glucose Monitoring in

Two Assisted Living Facilities

A. Counard, MD, MPH * , ph F. Perz, DrPH, MA † , Purisima C.

Linchangco, MPH * , Demian Christiansen, DSc * , Lilia Ganova-Raeva, MS, PhD ‡ ,

Guoliang Xia, MD ‡ , * 1 , and O. Vernon, DrPH *

From the *Communicable Disease Control Unit, Cook County Department of Public

Health, Oak Park, Illinois; and †Division of Healthcare Quality Promotion,

National Center for Preparedness Detection and Control of Infectious Diseases,

and ‡Division of Viral Hepatitis, National Center for HIV/AIDS, Viral

Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,

Atlanta, Georgia.

Address correspondence to A. Counard, Skokie Health Department, 5127

Oakton Street, Skokie, IL 60077. E-mail: catherine.counard@...

Copyright Journal compilation 2010 The American Geriatrics Society/Wiley

Periodicals, Inc.

ABSTRACT

OBJECTIVES: To establish the etiology for outbreaks of hepatitis B virus (HBV)

infections at two assisted living facilities (ALFs) and devise appropriate

control measures.

DESIGN: Multisite outbreak investigations, retrospective cohort.

SETTING: Two ALFs in Illinois.

PARTICIPANTS: Facility A residents (n=120) and Facility B residents (n=105) and

nursing staff (n=6).

MEASUREMENTS: For Facility A, a retrospective cohort study to identify risk

factors for HBV infection through serological testing of all residents and a

medical record extraction. For Facility A and B, investigation of fingerstick

blood glucose monitoring techniques. For Facility B, serological HBV testing of

nurses and residents receiving fingerstick blood glucose monitoring.

RESULTS: At Facility A, five confirmed acute, two probable acute, and one

probable chronic HBV infections were identified in the 109 residents tested. All

of the eight identified residents with HBV infection had diabetes mellitus. HBV

deoxyribonucleic acid (DNA) sequences from the chronic and acute cases were

identical. Transmission of HBV was associated with fingerstick blood glucose

monitoring (relative risk (RR)=28.5, 95% confidence interval (CI)=1.6–498;

P<.001) and insulin injections (RR=7.4, 95% CI=1.3–40.8; P=.03). At Facility B,

seven of 21 residents (33.3%) receiving fingerstick blood glucose monitoring had

evidence of recent HBV infection.

CONCLUSION: Nurses probably transmitted HBV infection from resident to resident

during fingerstick blood glucose monitoring in two separate ALFs, causing

outbreaks. Awareness of the high risk for HBV transmission during procedures for

the care of diabetes mellitus was limited. Following established infection

control measures is critical to prevent spread of this highly contagious virus.

--------------------------------------------------------------------------------

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2009.02669