title: Acute hepatitis B outbreaks related to fingerstick blood glucose monitoring in two assisted living facilities.
abstract: OBJECTIVE
  To establish the etiology for outbreaks of hepatitis B virus (HBV) infections at two assisted living facilities (ALFs) and devise appropriate control measures.
  
  
  METHODS
  Multisite outbreak investigations, retrospective cohort.
  
  
  METHODS
  Two ALFs in Illinois.
  
  
  METHODS
  Facility A residents (n=120) and Facility B residents (n=105) and nursing staff (n=6).
  
  
  METHODS
  For Facility A, a retrospective cohort study to identify risk factors for HBV infection through serological testing of all residents and a medical record extraction. For Facility A and B, investigation of fingerstick blood glucose monitoring techniques. For Facility B, serological HBV testing of nurses and residents receiving fingerstick blood glucose monitoring.
  
  
  RESULTS
  At Facility A, five confirmed acute, two probable acute, and one probable chronic HBV infections were identified in the 109 residents tested. All of the eight identified residents with HBV infection had diabetes mellitus. HBV deoxyribonucleic acid (DNA) sequences from the chronic and acute cases were identical. Transmission of HBV was associated with fingerstick blood glucose monitoring (relative risk (RR)=28.5, 95% confidence interval (CI)=1.6-498; P<.001) and insulin injections (RR=7.4, 95% CI=1.3-40.8; P=.03). At Facility B, seven of 21 residents (33.3%) receiving fingerstick blood glucose monitoring had evidence of recent HBV infection.
  
  
  CONCLUSIONS
  Nurses probably transmitted HBV infection from resident to resident during fingerstick blood glucose monitoring in two separate ALFs, causing outbreaks. Awareness of the high risk for HBV transmission during procedures for the care of diabetes mellitus was limited. Following established infection control measures is critical to prevent spread of this highly contagious virus.
authors.affiliation: Communicable Disease Control Unit, Cook County Department of Public Health, Oak Park, Illinois, USA. catherine.counard@skokie.org
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Counard
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
authors.forename: Purisima C
authors.initials: PC
authors.lastname: Linchangco
authors.forename: Demian
authors.initials: D
authors.lastname: Christiansen
authors.forename: Lilia
authors.initials: L
authors.lastname: Ganova-Raeva
authors.forename: Guoliang
authors.initials: G
authors.lastname: Xia
authors.forename: Steven
authors.initials: S
authors.lastname: Jones
authors.forename: Michael O
authors.initials: MO
authors.lastname: Vernon
mesh_terms: D000368:Aged; D040561:Assisted Living Facilities; D001800:Blood Specimen Collection / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood* / Q000451:nursing; D004196:Disease Outbreaks / Q000517:prevention & control*; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D017053:Infection Control / Q000379:methods; D008134:Long-Term Care; D012189:Retrospective Studies; D012307:Risk Factors