title: Transmission of hepatitis B virus associated with assisted monitoring of blood glucose at an assisted living facility in New York State.
abstract: BACKGROUND
  Hepatitis B virus (HBV) transmission has been reported after patient-to-patient blood exposure during assisted monitoring of blood glucose (AMBG). Three assisted-living facility (ALF) residents who underwent AMBG developed acute HBV infection (HBVI) within 10 days. We investigated HBV transmission and implemented preventive measures.
  
  
  METHODS
  A retrospective cohort study was conducted. Infection control practices were assessed. HBVI screening was conducted for all staff and epidemiologically linked residents. Viral DNA sequences were compared for a subset of isolates.
  
  
  RESULTS
  Lancing devices and glucometers were shared among residents without proper sanitization. Serologic testing of all 34 residents with diabetes and 12 epidemiologically linked residents present during the exposure period detected 6 residents with diabetes with current HBVI and 4 residents with diabetes and 1 epidemiologically linked resident with previous HBVI. A cohort study of 32 individuals with diabetes identified AMBG as a significant risk factor for HBVI (relative risk, 6.7; 95% confidence interval, 1.7-26.3). Viral DNA sequences for 5 AMBG-exposed residents' isolates were identical, suggesting a common source.
  
  
  CONCLUSIONS
  AMBG was significantly associated with HBVI in ALF residents with diabetes. Despite clear preventive recommendations, bloodborne pathogen transmission continues to occur in the setting of AMBG. Strengthening direct care provider, infection preventionist, and health department partnerships with ALFs is crucial to ensure safe AMBG practices and prevent HBV transmission.
authors.affiliation: Bureau of Communicable Disease Control, New York State Department of Health, Albany, NY, USA. Joshua.schaffzin@cchmc.org
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Schaffzin
authors.forename: Karen L
authors.initials: KL
authors.lastname: Southwick
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Clement
authors.forename: Franciscus
authors.initials: F
authors.lastname: Konings
authors.forename: Lilia
authors.initials: L
authors.lastname: Ganova-Raeva
authors.forename: Guoliang
authors.initials: G
authors.lastname: Xia
authors.forename: Yury
authors.initials: Y
authors.lastname: Khudyakov
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Johnson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission* / Q000821:virology; D003920:Diabetes Mellitus / Q000097:blood; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010802:Phylogeny; D012189:Retrospective Studies; D012307:Risk Factors