Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England

Abstract

BackgroundTransmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward.MethodsThe case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken.ResultsInvestigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission.ConclusionsPatient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.

Decline in hepatitis B and C prevalence among hemodialysis patients in Tocantins, Northern Brazil

“…In fact, outbreaks of viral hepatitis in the dialysis environment are not uncommon when infection control breaches occur 3 , 4 , 7 . Kliner et al 19 reported patient-to-patient transmission of HBV in a UK hemodialysis unit. According to these authors, the occurrence of this kind of event was attributed to non-compliance with infection control and prevention recommendations, which includes monitoring anti-HBs titers to indicate vaccination booster doses, when appropriate.…”

Vaccination of healthcare workers: A review

“…143 Several recent outbreaks involving patient-to-patient HBV transmission have been recorded. [144][145][146] Outbreaks mostly occurred in renal ward/hemodialysis patients and were frequently related to lack of infection control measures. 145,146 Transmission from HCWs to patients has also been observed.…”

“…[144][145][146] Outbreaks mostly occurred in renal ward/hemodialysis patients and were frequently related to lack of infection control measures. 145,146 Transmission from HCWs to patients has also been observed. 147 The risk of HCWs acquiring HBV infection is related to the extent of percutaneous or mucosal exposure to blood and other bodily fluids.…”

Healthcare-associated infections: new challenges looking for answers

“…In this issue, Kliner et al [ 3 ] report a case of hepatitis B virus contagion in an inpatient renal ward. Hepatitis B has been considered a major risk among haemodialysis patients and healthcare workers since the early times of the technique.…”

“…The published case illustrates the need for a full epidemiological work-up in the case a recent hepatitis B infection is diagnosed. Thus, careful research following a new case of hepatitis B virus infection uncovered many failures, including poor vaccination status of patients and many violations of universal infection control measures, such as poor hand hygiene and visible contamination of blood glucose testing equipment [ 3 ]. It was concluded that patient-to-patient transmission was likely to have occurred on the renal ward due to multiple failures in infection control.…”