Thirty-three outbreaks in non-hospital settings and seven hospital outbreaks are examined in a recent study by the Centers for Disease Control and Prevention (CDC). Multiple failures in basic infection control practices in non-hospital settings such as the reuse of syringes has led to the testing of over 60,000 U.S. patients for viral hepatitis.

The total outbreaks outside of hospitals in 15 states identified during the past decade included 12 in outpatient clinics, six in hemodialysis centers and 15 in long-term care facilities, resulting in more than 400 people acquiring HBV or HCV infection. The outbreaks are described in a recent review (Annals of Internal Medicine, January 6, 2009) of all healthcare-associated viral hepatitis outbreaks investigated by the CDC over the last 10 years.

Infection practice lapses This number is likely an under-representation, as test results and epidemiologic information were not always available. Healthcare personnel (HCP) failed to follow several basic infection control procedures and aseptic technique in injection safety, including reusing syringes, contaminating multi-dose vials with unclean syringes, using single-dose vials for multiple patients, re-using end-caps from single-use syringes, using fingerstick devices on multiple patients without cleaning, and using blood-sugar measuring devices on multiple patients without cleaning.

Dr. Denise Cardo, director of CDCŒs Division of Healthcare Quality Promotion, noted that more innovative engineering controls and public awareness are needed because more patients in the United States are receiving their healthcare in outpatient settings. The report highlights the need for ongoing professional education for healthcare providers. By contrast, unpublished CDC data from hospital settings identified only seven incidents of viral hepatitis outbreaks, resulting in 48 individuals acquiring HBV or HCV infection.

Recommendations for infection prevention and control in hospital settings are well established and infection prevention specialists conduct surveillance, monitor practices and provide education and training on appropriate infection control practices. In non-hospital settings, such specific infection control resources and oversight are not always in place.

Recommendations The CDC review emphasizes the need for more education specifically related to aseptic technique in injection safety, regular review of practices and training, and the implementation of a consistent state oversight in detecting and preventing the transmission of bloodborne pathogens in healthcare settings. The review also indicates that the continuing outbreak activity may lead to recommendations for hepatitis B vaccination for diabetic long-term care residents.