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Hepatitis Outbreaks in Nonhospital Healthcare Facilities

Lapses in infection-control practices at outpatient care settings resulted in hundreds of hepatitis B and C cases and put thousands of people at risk.

Healthcare-associated transmission of hepatitis B and C viruses in the U.S. has been thought to be rare. But now, CDC researchers reviewing hepatitis B and C outbreaks reported between June 1998 and June 2008 have found evidence that nonadherence to basic infection-control (IC) practices at some nonhospital healthcare settings (e.g., outpatient clinics, hemodialysis centers, long-term care facilities) is putting patients at risk for these diseases.

The reviewers identified 33 outbreaks of hepatitis B or C in nonhospital healthcare settings in the U.S. during the study period. Seventeen outbreaks involved hepatitis B, 15 involved hepatitis C, and 1 involved both; 448 patients were infected. Twelve outbreaks occurred in outpatient clinics (including endoscopy units), 6 in dialysis centers, and 15 in long-term care facilities. For many of these outbreaks, person-to-person spread was confirmed by demonstration of genetic relatedness among viral isolates.

In all the outbreaks, investigators uncovered significant breaches of the most basic IC principles — for example, reuse of syringes or lancing devices, contamination of medication vials by using them for multiple patients, and lapses in hand hygiene. Nearly 60,000 people were put at risk because of these faulty or deficient practices. The authors deemed all the outbreaks to have been preventable.

Comment: The absence of IC at its most rudimentary level is the root cause of these outbreaks. As the authors note, additional (but nonreported) outbreaks probably occurred. Increasing financial constraints will almost certainly lead to additional apparent cost-cutting through reuse of materials intended for single use, and to other IC lapses. Any short-term financial gains will be more than offset by the cost of care for patients with hepatitis. A comprehensive program including increased vigilance, healthcare provider education, and adherence to proper IC policies is needed to protect against transmission of hepatitis B and C viruses in healthcare settings — both hospital and nonhospital.

— Stephen G. Baum, MD

Published in Journal Watch Infectious Diseases January 14, 2009

Citation(s):

Thompson ND et al. Nonhospital health care–associated hepatitis B and C virus transmission: United States, 1998–2008. Ann Intern Med 2009 Jan 6; 150:33.

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