Abstract
PURPOSE: Three patients with acute hepatitis B virus infection were identified who
had been hospitalized on the same medical ward during a 19-day period several months
earlier. An investigation was undertaken to determine if nosocomial transmission had
occurred.
SUBJECTS AND METHODS: A cohort study of patients admitted to the medical ward during
the 19-day period in 1995 was conducted. In addition, we reviewed medical charts and
laboratory records of all patients with acute hepatitis B virus infection who had
been admitted to the hospital from 1992 through October 1996 to identify other cases
with possible nosocomial acquisition.
RESULTS: The 3 patients who had developed acute hepatitis B infection 2 to 5 months
after hospitalization on the same medical ward had diabetes mellitus but no identified
risk factors for hepatitis B infection. A source patient with diabetes mellitus and
hepatitis B “e” antigenemia also was present on the same medical ward at the same
time; all 4 patients were infected with the same viral subtype (adw2). Diabetes mellitus and fingerstick monitoring were associated with illness (P <0.001). Through the review of medical charts and laboratory records, 11 additional
cases of suspected nosocomial acquisition via fingersticks were identified in 1996,
including two clusters involving an unusual subtype of hepatitis B virus (adw4). The fingerstick device employed had a reusable base onto which disposable lancet
caps were inserted. There was ample opportunity for cross-contamination among patients
because deficiencies in infection control practices, particularly failure to change
gloves between patients, were reported by nurses and patients with diabetes mellitus.
CONCLUSION: Transmission during fingerstick procedures was the most likely cause of
these cases of nosocomial hepatitis B infection. Contamination probably occurred when
health-care workers failed to change gloves between patients undergoing fingerstick
monitoring, although other means of contamination cannot be ruled out.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
June 1,
1998
Received in revised form:
June 1,
1998
Received:
October 2,
1997
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
