HAV outbreak traced back to undiagnosed patient, hand hygiene breaches
A hepatitis A virus outbreak among patients and health care workers at a community hospital was traced back to an undiagnosed patient with a history of homelessness and substance abuse, researchers reported.
They added that breaches in hand hygiene protocols and proper gown use contributed to the nosocomial spread.
“The Tennessee Department of Health was notified that two health care workers at a hospital had laboratory-confirmed hepatitis A infection,” Infectious Disease News Editorial Board Member William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, said in an interview. “The health department initiated an investigation to determine whether the two infections might have been acquired in the occupational setting, which would have been an unusual event.”
Schaffner and colleagues interviewed health care workers with suspected or confirmed HAV infection and reviewed patient medical records and hospital administrative records to identify common exposures.
The study, which was published in Infection Control & Hospital Epidemiology, revealed that six health care workers and two patients had laboratory-confirmed HAV infection. Seven serum specimens showed that they belonged to an identical strain of HAV genotype 1b. According to Schaffner, all cases likely resulted from exposure to a seriously ill homeless patient with a history of substance abuse and undiagnosed HAV infection. He said breaches in hand hygiene and standard precautions contributed to the nosocomial acquisition.
According to the study, health care workers reported a variety of hand hygiene practices — some adhered to appropriate hand hygiene protocols and wore double gloves so they could remove the outer layer and keep a remaining set of clean gloves. Other health care workers reported wearing only gowns when tending to patients on contact precautions, or instead of wearing a gown they used pillowcases to create a barrier with patients who had diarrhea but no contact precautions.
“Medical providers should consider hepatitis A among patients with a history of substance abuse and homelessness,” Schaffner said. “The likelihood of nosocomial transmission can be reduced by adherence to proper hand hygiene, standard precautions and routine disinfection.”
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