title: Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009.
abstract: BACKGROUND
  Transmission of bloodborne pathogens due to breaches in infection control is becoming increasingly recognized as greater emphasis is placed on reducing health care-associated infections. Two women, aged 60 and 77 years, were diagnosed with acute hepatitis B virus (HBV) infection; both received chemotherapy at the same physician's office. Due to suspicion of health care-associated HBV transmission, a multidisciplinary team initiated an investigation of the hematology-oncology office practice.
  
  
  METHODS
  We performed an onsite inspection and environmental assessment, staff interviews, records review, and observation of staff practices. Patients who visited the office practice between January 1, 2006 and March 3, 2009 were advised to seek testing for bloodborne pathogens. Patients and medical providers were interviewed. Specimens from HBV-infected patients were sent to the Centers for Disease Control and Prevention for HBV DNA testing and phylogenic analysis.
  
  
  RESULTS
  Multiple breaches in infection control were identified, including deficient policies and procedures, improper hand hygiene, medication preparation in a blood processing area, common-use saline bags, and reuse of single-dose vials. The office practice was closed, and the physician's license was suspended. Out of 2,700 patients notified, test results were available for 1,394 (51.6%). Twenty-nine outbreak-associated HBV cases were identified. Specimens from 11 case-patients demonstrated 99.9%-100% nucleotide identity on phylogenetic analysis.
  
  
  CONCLUSIONS
  Systematic breaches in infection control led to ongoing transmission of HBV infection among patients undergoing invasive procedures at the office practice. This investigation underscores the need for improved regulatory oversight of outpatient health care settings, improved infection control and injection safety education for health care providers, and the development of mechanisms for ongoing communication and cooperation among public health agencies.
authors.affiliation: Council of State and Territorial Epidemiologists, Trenton, NJ; New Jersey Department of Health and Senior Services, Trenton, NJ. Electronic address: Rebecca.greeley@doh.state.nj.us.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Greeley
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Shereen
authors.initials: S
authors.lastname: Semple
authors.affiliation: Epidemiology and Surveillance Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Nicola D
authors.initials: ND
authors.lastname: Thompson
authors.affiliation: Ocean County Health Department, Toms River, NJ.
authors.forename: Patricia
authors.initials: P
authors.lastname: High
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Ellen
authors.initials: E
authors.lastname: Rudowski
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Handschur
authors.affiliation: Laboratory Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Xia
authors.affiliation: Laboratory Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Lilia
authors.initials: L
authors.lastname: Ganova-Raeva
authors.affiliation: Ocean County Health Department, Toms River, NJ.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Crawford
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Corwin
authors.initials: C
authors.lastname: Robertson
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Christina
authors.initials: C
authors.lastname: Tan
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.
authors.forename: Barbara
authors.initials: B
authors.lastname: Montana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017848:Blood-Borne Pathogens; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D006405:Hematology; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control; D007267:Injections / Q000009:adverse effects; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D010802:Phylogeny; D010824:Physicians' Offices / Q000706:statistics & numerical data*; D017422:Sequence Analysis, DNA