Failure to Follow Infection Prevention Guidance Puts Patients at Risk for Hepatitis

More than 60,000 patients in the United States were put at risk for infection with hepatitis B or hepatitis C virus during the past decade because health care workers failed to follow basic infection control practices. That is among the findings in a recent CDC study that was published in the Jan. 6 issue of Annals of Internal Medicine.

A review of CDC information reveals 33 outbreaks in 15 states have occurred during the past 10 years. A dozen of the outbreaks were linked to outpatient clinics, six to hemodialysis centers and 15 to long-term care facilities.

The lapses in infection prevention resulted in a total of 450 reported hepatitis infections. Six patients in long-term care facilities died of hepatitis B infections.

According to the report, reuse of syringes and blood contamination of medications, equipment and devices were common factors in the outbreaks.

"Contributing to the problem are carelessness, cutting corners, lack of education and a complacency that sometimes emerges when populations feel 'protected' from infectious disease," said Jonathan Temte, M.D., Ph.D., an associate professor in the department of family medicine at the University of Wisconsin, Madison, and a member of the CDC's Advisory Committee on Immunization Practices.

Temte said that, overall, there has been "remarkable uptake" of universal infection precautions implemented in the wake of the identification of HIV in the 1980s.

"Accordingly, it is wonderful to see how often such exposures are not occurring," he said. "Yet, this report of 60,000 exposures and 450 avoidable cases reminds us all to practice carefully."

The report notes that recommendations for infection prevention and control in hospital settings are well established and updated on a regular basis, and infection control personnel are employed to conduct surveillance, monitor practices, and provide education and training on appropriate infection control practices. However, the report adds, "specific infection control resources and oversight have traditionally been lacking in nonhospital settings."

Meanwhile, more patients are seeking care in outpatient settings.

Temte said physicians should review their infection control practices annually and ensure that health care workers have received all recommended vaccines. He said additional efforts should be made to identify patients at increased risk so they can be screened, vaccinated or both.