title: Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device.
abstract: METHODS
  From June 1989 through March 1990, 26 patients, of whom 23 had diabetes, contracted acute hepatitis B virus (HBV) infection in a hospital in California. All 26 patients and one HBV carrier (also a diabetic) had been admitted to a single medical ward during the six months before the case patients became infected with HBV. To determine the source of the infection, we conducted a retrospective cohort study of the 72 patients with diabetes who had been admitted to the ward from January through December 1989 and a case-control study comparing the 3 nondiabetic patients who contracted hepatitis with 20 nondiabetic controls.
  
  
  RESULTS
  The retrospective cohort study of all the patients with diabetes who were admitted to the ward during 1989 found that those who underwent capillary blood sampling by finger stick with a spring-loaded lancet device were more likely to contract HBV infection than those who did not have finger sticks (attack rate, 42 percent vs. 0 percent; P = 0.08). In addition, a dose-response relation was observed between the number of finger sticks received and the frequency of hepatitis B (P = 0.002). The case-control study found that all 3 of the nondiabetic patients who contracted hepatitis underwent finger-stick blood sampling with the device, as compared with none of the 20 nondiabetic controls (P = 0.0006). A review of nursing procedures indicated that the platform of the device was not routinely changed after each use; this finding suggested that contamination of the platform by HBV-infected blood was the mechanism of percutaneous transmission of HBV.
  
  
  CONCLUSIONS
  Proper use of finger-stick devices as well as strict adherence to universal precautions to avoid contamination by blood are required to decrease the possibility of transmission of blood-borne pathogens among hospitalized patients.
authors.affiliation: Hepatitis Branch, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: L B
authors.initials: LB
authors.lastname: Polish
authors.forename: C N
authors.initials: CN
authors.lastname: Shapiro
authors.forename: F
authors.initials: F
authors.lastname: Bauer
authors.forename: P
authors.initials: P
authors.lastname: Klotz
authors.forename: P
authors.initials: P
authors.lastname: Ginier
authors.forename: R R
authors.initials: RR
authors.lastname: Roberto
authors.forename: H S
authors.initials: HS
authors.lastname: Margolis
authors.forename: M J
authors.initials: MJ
authors.lastname: Alter
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001800:Blood Specimen Collection / Q000295:instrumentation*; D002140:California; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000635:transmission*; D003920:Diabetes Mellitus / Q000097:blood; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D005385:Fingers; D006509:Hepatitis B / Q000635:transmission*; D006744:Hospital Bed Capacity, 100 to 299; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies