title: Deja vu: nosocomial hepatitis B virus transmission and fingerstick monitoring.
abstract: OBJECTIVE
  Three patients with acute hepatitis B virus infection were identified who had been hospitalized on the same medical ward during a 19-day period several months earlier. An investigation was undertaken to determine if nosocomial transmission had occurred.
  
  
  METHODS
  A cohort study of patients admitted to the medical ward during the 19-day period in 1995 was conducted. In addition, we reviewed medical charts and laboratory records of all patients with acute hepatitis B virus infection who had been admitted to the hospital from 1992 through October 1996 to identify other cases with possible nosocomial acquisition.
  
  
  RESULTS
  The 3 patients who had developed acute hepatitis B infection 2 to 5 months after hospitalization on the same medical ward had diabetes mellitus but no identified risk factors for hepatitis B infection. A source patient with diabetes mellitus and hepatitis B "e" antigenemia also was present on the same medical ward at the same time; all 4 patients were infected with the same viral subtype (adw2). Diabetes mellitus and fingerstick monitoring were associated with illness (P <0.001). Through the review of medical charts and laboratory records, 11 additional cases of suspected nosocomial acquisition via fingersticks were identified in 1996, including two clusters involving an unusual subtype of hepatitis B virus (adw4). The fingerstick device employed had a reusable base onto which disposable lancet caps were inserted. There was ample opportunity for cross-contamination among patients because deficiencies in infection control practices, particularly failure to change gloves between patients, were reported by nurses and patients with diabetes mellitus.
  
  
  CONCLUSIONS
  Transmission during fingerstick procedures was the most likely cause of these cases of nosocomial hepatitis B infection. Contamination probably occurred when healthcare workers failed to change gloves between patients undergoing fingerstick monitoring, although other means of contamination cannot be ruled out.
authors.affiliation: Department of Veterans Affairs Medical Center, Brooklyn, New York, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Quale
authors.forename: D
authors.initials: D
authors.lastname: Landman
authors.forename: B
authors.initials: B
authors.lastname: Wallace
authors.forename: E
authors.initials: E
authors.lastname: Atwood
authors.forename: V
authors.initials: V
authors.lastname: Ditore
authors.forename: G
authors.initials: G
authors.lastname: Fruchter
mesh_terms: D000368:Aged; D001800:Blood Specimen Collection / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000517:prevention & control / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000097:blood; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control / Q000379:methods; D017757:Infectious Disease Transmission, Professional-to-Patient; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009518:New York; D011159:Population Surveillance; D012189:Retrospective Studies
chemical_list: D006510:Hepatitis B Antibodies