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Nosocomial Transmission of Hepatitis B Virus Infection Among Residents with Diabetes in a Skilled Nursing Facility

Published online by Cambridge University Press:  02 January 2015

Amy J. Khan ,
Suzanne M. Cotter ,
Beth Schulz ,
Xiaolei Hu ,
Jon Rosenberg ,
Betty H. Robertson ,
Anthony E. Fiore  and
Beth P. Bell
Amy J. Khan*
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Suzanne M. Cotter
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Beth Schulz
Affiliation:
Mateo County Health Department, San Mateo, California
Xiaolei Hu
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Jon Rosenberg
Affiliation:
Division of Communicable Disease Control, California Department of Health Services, Berkeley, California
Betty H. Robertson
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Anthony E. Fiore
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Beth P. Bell
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA30333
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Abstract

Objective:

To identify exposures associated with acute hepatitis B virus (HBV) infection among residents with diabetes in a skilled nursing facility.

Design:

Residents from Unit 3 and other skilled nursing facility residents with diabetes were tested for serologic evidence of HBV infection. Two retrospective cohort studies were conducted. Potential routes of HBV transmission were evaluated by statistical comparison of attack rates.

Setting:

A 269-bed skilled nursing facility.

Participants:

All skilled nursing facility residents with diabetes and skilled nursing facility residents who lived on the same unit as the index case (Unit 3) for some time during the case's incubation period.

Results:

All 5 residents with acute HBV infection had diabetes and resided in Unit 3. The attack rate among the 12 patients with diabetes in Unit 3 was 42%, compared with 0% among 43 patients without diabetes (relative risk, 37.2; 95% confidence interval, 4.7 to ∞). Acutely infected patients with diabetes received more morning insulin doses (P = .05), and more insulin doses (P = .03) and finger sticks (P = .02) on Wednesdays than did noninfected patients with diabetes. Two chronically infected patients with diabetes in Unit 3 were positive for hepatitis B e antigen and regularly received daily insulin and finger sticks. Of the 4 acute and 3 chronically infected residents from whom HBV DNA was amplified, all were genotype F and had an identical 678-bp S region sequence. Although no component of the lancets or injection devices was shared among residents, opportunities for HBV contamination of diabetes care supplies were identified.

Conclusions:

Contamination of diabetes care supplies resulted in resident-to-resident transmission of HBV. In any setting in which diabetes care is performed, staff need to be educated regarding appropriate infection control practices.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 6 , June 2002 , pp. 313 - 318
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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