|Z. Moore, MD; J.-M. Maillard, MD; M. Davies, MD; N.
Sharing of blood glucose monitoring equipment at
assisted-living facilities has been linked to at least 16 US outbreaks of
hepatitis B virus infection since 2004. In the current report, state and CDC
authors detail an HBV outbreak at such a facility in North Carolina.
On Oct. 12, 2010, a local hospital notified state and
county health officials that four residents of a single assisted-living
facility had suspected acute HBV infection. North Carolina Division of
Public Health (NCDPH) requested HBV testing of all who were residents of the
assisted-living facility Jan. 1-Oct. 13, 2010. Records were reviewed for
possible care-associated exposures and HBV risk factors. A review of
infection control practices included observations as well as interviews of
Investigators discovered the sharing of reusable
fingerstick lancing devices, though they were only approved for
single-patient use, as well as the sharing of blood glucose meters without
cleaning and disinfecting between patients. Of eight residents who met
criteria for outbreak-associated HBV, all had been hospitalized and six had
died from hepatitis complications. All were among the 15 facility residents
assisted in monitoring blood glucose; no one who had not been assisted with
blood glucose monitoring was infected.
"Despite long-standing and recently expanded infection
control recommendations, HBV transmission continues to occur through sharing
of fingerstick lancing devices and other blood glucose monitoring
equipment," the report said. "These practices put residents at risk for
severe illness and death. In accordance with NCDPH recommendations, the
facility now uses individually assigned blood glucose meters and single-use,
auto disabling finger stick lancing devices. The facility also offered HBV
vaccine to all susceptible residents. NCDPH and the state licensing agency
issued a notification to all health care providers and licensed health care
facilities statewide warning of the potential for HBV transmission through
unsafe diabetes care practices.
"This outbreak underscores the need for increased efforts
to promote compliance with infection control guidelines in assisted-living
facilities," the authors concluded.