A review of hepatitis B and C virus infection outbreaks in healthcare settings, 2008-2009: Opening our eyes to viral hepatitis as a healthcare-associated infection

Background: Outbreaks of healthcare-associated hepatitis B and C virus (HBV and HCV) infections were thought to be rare in the United States.  However, a recent review showed that from 1998-2008, 40 outbreaks were investigated; these involved more than 500 patients who became infected with HBV or HCV in a wide variety of healthcare settings.

Objective: To describe the most recent burden of healthcare-associated HBV and HCV infection outbreaks, we reviewed outbreak investigation reports from the past year.

Methods: Reports to CDC of potential healthcare-associated HBV or HCV transmission between July 2008 and June 2009 were reviewed. A healthcare-associated outbreak was defined as ≥2 persons diagnosed with acute or newly acquired HBV or HCV infection and epidemiologically linked to a common healthcare provider or facility.

Results: Eleven outbreaks of healthcare-associated HBV and HCV infection in 10 states  were identified during the study period; at least 120 persons acquired HBV or HCV infection during the receipt of healthcare. Nine outbreaks occurred in nonhospital settings; either outpatient medical clinics (n=4), chronic hemodialysis units (n=3) or long-term care facilities (n=2). All nine involved patient-to-patient transmission (97 total patients infected); all were associated with breaches in infection control practices. The primary modes of transmission were failures to maintain aseptic technique when using parenteral medications (i.e., syringe reuse or other unsafe injection practices) in medical clinics, parenteral medication and environmental contamination in hemodialysis units, and the reuse of contaminated equipment or supplies on multiple patients in long-term care facilities. Two outbreaks occurred in acute care hospitals, both involved provider-to-patient transmission. The first involved an HBV-infected surgeon with no clear infection control breach identified (2 patients infected), whereas the other involved an HCV-infected surgical technician who infected patients while diverting narcotics and reusing syringes (21 patients infected).

Conclusions: A large number of healthcare-associated HBV and HCV infection outbreaks were investigated during the study period, involving predominately patient-to-patient transmission. Outbreak detection in not systematic, so continued efforts to raise awareness and increase resources to facilitate the detection and investigation of healthcare-associated HBV and HCV infections remain much needed. The emerging awareness of the significant role of healthcare in viral hepatitis transmission in the United States highlights the urgency for prevention efforts, including education and training in basic infection control practices and improved oversight and regulation, to be addressed in all venues that deliver health care.