Quale J M, Landman D, Wallace B, Atwood E, Ditore V, Fruchter G
Department of Veterans Affairs Medical Center, Brooklyn, New York, USA.
Am J Med. 1998 Oct;105(4):296-301. doi: 10.1016/s0002-9343(98)00256-3.
Three patients with acute hepatitis B virus infection were identified who had been hospitalized on the same medical ward during a 19-day period several months earlier. An investigation was undertaken to determine if nosocomial transmission had occurred.
A cohort study of patients admitted to the medical ward during the 19-day period in 1995 was conducted. In addition, we reviewed medical charts and laboratory records of all patients with acute hepatitis B virus infection who had been admitted to the hospital from 1992 through October 1996 to identify other cases with possible nosocomial acquisition.
The 3 patients who had developed acute hepatitis B infection 2 to 5 months after hospitalization on the same medical ward had diabetes mellitus but no identified risk factors for hepatitis B infection. A source patient with diabetes mellitus and hepatitis B "e" antigenemia also was present on the same medical ward at the same time; all 4 patients were infected with the same viral subtype (adw2). Diabetes mellitus and fingerstick monitoring were associated with illness (P <0.001). Through the review of medical charts and laboratory records, 11 additional cases of suspected nosocomial acquisition via fingersticks were identified in 1996, including two clusters involving an unusual subtype of hepatitis B virus (adw4). The fingerstick device employed had a reusable base onto which disposable lancet caps were inserted. There was ample opportunity for cross-contamination among patients because deficiencies in infection control practices, particularly failure to change gloves between patients, were reported by nurses and patients with diabetes mellitus.
Transmission during fingerstick procedures was the most likely cause of these cases of nosocomial hepatitis B infection. Contamination probably occurred when healthcare workers failed to change gloves between patients undergoing fingerstick monitoring, although other means of contamination cannot be ruled out.
发现了3例急性乙型肝炎病毒感染患者，他们在数月前的19天内曾在同一内科病房住院。开展了一项调查以确定是否发生了医院内传播。
对1995年那19天期间入住该内科病房的患者进行了队列研究。此外，我们查阅了1992年至1996年10月期间入院的所有急性乙型肝炎病毒感染患者的病历和实验室记录，以确定其他可能通过医院感染获得的病例。
在同一内科病房住院2至5个月后发生急性乙型肝炎感染的3例患者患有糖尿病，但未发现乙型肝炎感染的危险因素。同一内科病房同时还存在一名患有糖尿病且乙肝“e”抗原血症的源患者；所有4例患者均感染了相同的病毒亚型（adw2）。糖尿病和指尖采血监测与发病有关（P<0.001）。通过查阅病历和实验室记录，1996年又发现了11例疑似通过指尖采血发生医院感染的病例，其中包括两起涉及一种不寻常的乙型肝炎病毒亚型（adw4）的聚集性病例。所使用的指尖采血装置有一个可重复使用的底座，上面插入一次性采血针帽。由于感染控制措施存在缺陷，尤其是护士和糖尿病患者报告在不同患者之间未更换手套，患者之间有充分的交叉污染机会。
这些医院内乙型肝炎感染病例最可能的原因是指尖采血过程中的传播。医护人员在为接受指尖采血监测的患者之间未更换手套时可能发生了污染，尽管不能排除其他污染途径。
