title: Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England.
abstract: BACKGROUND
  Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward.
  
  
  METHODS
  The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken.
  
  
  RESULTS
  Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission.
  
  
  CONCLUSIONS
  Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.
authors.affiliation: Cheshire and Mersey Health Protection Team , Public Health England , Liverpool , UK.
authors.forename: Merav
authors.initials: M
authors.lastname: Kliner
authors.affiliation: Cheshire and Mersey Health Protection Team , Public Health England , Liverpool , UK.
authors.forename: Evdokia
authors.initials: E
authors.lastname: Dardamissis
authors.affiliation: Aintree University Hospitals NHS Trust and Liverpool Hope Hospital , Liverpool , UK.
authors.forename: K Abraham
authors.initials: KA
authors.lastname: Abraham
authors.affiliation: Aintree University Hospitals NHS Trust and Liverpool Hope Hospital , Liverpool , UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sen
authors.affiliation: Aintree University Hospitals NHS Trust and Liverpool Hope Hospital , Liverpool , UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Lal
authors.affiliation: Aintree University Hospitals NHS Trust and Liverpool Hope Hospital , Liverpool , UK.
authors.forename: Bhavna
authors.initials: B
authors.lastname: Pandya
authors.affiliation: Public Health England Laboratory , Manchester , UK.
authors.forename: Ken J
authors.initials: KJ
authors.lastname: Mutton
authors.affiliation: Aintree University Hospitals NHS Trust and Liverpool Hope Hospital , Liverpool , UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wong
keywords: chronic kidney disease; cross infection; hepatitis B; nosocomial infections