Five hepatitis B outbreaks in care homes in the UK associated with deficiencies in infection control practice in blood glucose monitoring

Abstract

Healthcare-associated hepatitis B virus (HBV) outbreaks have been reported in the USA and from several countries in Europe. Patient-to-patient transmission of HBV in these settings has been linked to several different types of exposure but one of the most common exposures implicated is the use of 'finger-stick' lancet devices for blood glucose testing. This article is an account of the investigations into a series of HBV outbreaks linked to the use of lancing devices in community healthcare settings in the UK. Between February 2004 and December 2006, nine individuals with acute HBV infection were reported to five local units of the Health Protection Agency. Investigations identified a further 12 individuals with HBV infection in residents in these settings. The epidemiological and environmental evidence suggests that HBV transmission occurred mostly from a significant breakdown in infection control measures in blood glucose testing. The occurrence of these outbreaks has highlighted the confusion that exists and the need for clear recommendations regarding the use of such devices in the UK.

“Never Events”: Hepatitis B Outbreaks and Patient Notifications Resulting from Unsafe Practices during Assisted Monitoring of Blood Glucose, 2009–2010

“…14 Hepatitis B virus infection outbreaks due to infection control breaches and equipment misuse during the delivery of AMBG have been identified with increasing frequency over the past few decades. [3][4][5][6][7][8][9][10] Increasing prevalence and diagnosis of diabetes among the aging U.S. population 21,22 along with increasing reliance on AMBG services indicate that there will be a growing at-risk population. There is a need for renewed and improved prevention efforts.…”

“…8 Investigators from the United Kingdom similarly concluded that confusion regarding the correct use of BG monitoring equipment was a contributing factor to HBV transmission. 6 They reported that models intended for self-use (i.e., SMBG) and professional use (i.e., AMBG) were very difficult to distinguish from one another and that the manufacturer's information that accompanies devices was often unclear. Ultimately, the accountability for providing safe care rests with the facilities and personnel who are providing AMBG.…”

“…There exists a long history of hepatitis B virus (HBV) infection outbreaks in the United States and elsewhere due to poor infection control practices while delivering AMBG to multiple persons. [3][4][5][6][7][8] Outbreak investigations have clearly illustrated that opportunities for bloodborne pathogen transmission exist when equipment used for AMBG is not dedicated for individual patient use (i.e., finger stick devices) or not cleaned and disinfected between each use (i.e., BG meters). Despite sustained efforts to publicize this risk and recommended prevention practices, 4,[9][10] HBV infection outbreaks continue to occur in settings where AMBG is provided, therefore, additional partners in the prevention effort are needed.…”

Hepatitis B vaccination coverage in patients with diabetes mellitus

“…These procedures can lead to situations where syringes, needles and blood glucose monitoring devices are shared (1)(2)(3) . The literature describes various outbreaks of hepatitis B in DM patients (3)(4)(5) . In 2011, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) in the United States, recommended, based on evidence, hepatitis B vaccination for DM patients from ages 19 to 59, once a diagnosis is made, and for those aged 60 and older, after assessment of the risk and likelihood of an adequate immune response to vaccination (6) .…”

Hepatitis B Vaccination Rate in Patients with Diabetes: Assessment of Racial and Socioeconomic Disparity

“…Recent evidence show that hepatitis B infection occurs more frequently among individuals with type 2 diabetes than the general population [1][2][3]. The odds for developing acute hepatitis B for individuals with diabetes is said to be as much as twice that for non-diabetics.…”