Public Health

Patient-to-patient transmission of hepatitis B tied to lapses in infection control

Last Updated: 2009-04-20 11:48:48 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Breaches in infection-control measures during several routine clinical practices can result in patient-to-patient transmission of hepatitis B virus (HBV), according to a systematic review by Italian researchers. The review, which sought to identify the most frequent infection pathways and clinical settings involved in such instances, is reported in the online journal BMC Medicine for April 8.

The authors identified 30 published papers that reported on a total of 33 HBV outbreaks in the United States and the European Union involving 471 patients and 16 fatalities.

Dialysis units were the site of 30.3% of the outbreaks, and medical wards and nursing homes were tied as the second most common sites, at 21.2% each. Following them were surgical wards (15.2%) and outpatient clinics (12.1%). Hematology units were the most common among medical wards, and heart-transplant units the most frequent among surgical wards.

"The transmission pathways identified were: multi-vial drugs (30.3%), non-disposable multi-patient capillary blood sampling devices (27.2%), transvenous endomyocardial biopsy procedures (9.1%) and multiple deficiencies in applying standard precautions (9.1%)."

Lead investigator Dr. Simone Lanini of the National Institute for Infectious Diseases, Rome, told Reuters Health that this systematic review is the first to focus on patient-to-patient HBV transmission in healthcare settings. Unlike previous papers, he said, this study included outbreaks from multiple countries and included both hospital and non-hospital settings.

The researchers conclude that healthcare workers need to adhere to standard infection-control principles, such as using sterile, single-use, disposable needles and avoiding the use of multi-vial compounds in any healthcare setting, including outpatient settings.

Going forward, Dr. Lanini commented, "Although things have been changing, we strongly believe that the quality of research in hospital epidemiology must be further improved."

Similarly, hospital epidemiology needs "a more careful assessment of the role of environmental and/or medical device contamination in spreading several viral infections, such as blood-borne infections." Dr. Lanini noted that while bacterial infections have been widely investigated in this context, much less information is available on viral contamination.

BMC Med 2009.