Epidemiology

Glucose monitoring tied to HBV transmission at nursing homes

Last Updated: 2005-03-11 15:38:31 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The spread of hepatitis B virus (HBV) at three long-term-care facilities in the US seems to have resulted from the sharing of blood glucose monitoring equipment, according to findings in the March 11th Morbidity and Mortality Weekly Report.

The outbreaks, which occurred in 2003 and 2004, involved centers in Mississippi, California, and North Carolina. However, this is not the first time that HBV transmission has been tied to the sharing of glucose monitoring supplies, study co-author Dr. Anthony Fiore, from the Centers for Disease Control and Prevention in Atlanta, told Reuters Health.

"We've reported on these types of outbreaks numerous times in the past," Dr. Fiore noted. The fact that they keep happening suggests that recommended sterility practices need to be reinforced, he added.

The outbreak in Mississippi involved a nursing home with two fatal cases of acute HBV infection. The resulting investigation revealed that 15 residents had acute HBV infection and all but one received routine fingersticks for blood glucose testing. Staff interviews indicated that although the needles themselves were not shared, other equipment was.

In California, four diabetic residents at an assisted living center were diagnosed with acute HBV infection. Eight cases were eventually uncovered and all were linked to fingersticks performed by the nursing staff. Once again, it appeared that glucose monitoring equipment was being shared by the residents.

The North Carolina outbreak started with one case of HBV infection detected in May 2003. Subsequent testing of all residents uncovered a total of 11 cases of acute infection. Although cases were not confined to patients tested for glucose, such patients were 6.9-times more likely to be infected than those who had not been tested. Staff interviews revealed that glucometers were often shared between patients and seldom cleaned.

"The common theme that ran through these outbreaks is that diabetes care supplies were being used on multiple patients," Dr. Fiore said. "Still, it's not exactly clear in any of the outbreaks which practices actually transmitted HBV."

Mor Mortal Wkly Rep CDC Surveill Summ 2005;54:220-223.