Snydman D R, Hindman S H, Wineland M D, Bryan J A, Maynard J E
Ann Intern Med. 1976 Nov;85(5):573-7. doi: 10.7326/0003-4819-85-5-573.
In a 2-month period four cases of hepatitis B occurred in hospital staff. Three months later two patients, hospitalized for open-heart surgery when the staff members had been infected, developed acute hepatitis B. Sera from all six ill individuals were subtype ayw and e-determinant positive. Epidemiologic investigation showed that the four staff had been exposed 3 months earlier to an asymptomatic hepatitis B surface antigen-positive (HBsAg) patient who was also e positive. To determine transmission from staff to patients study of 17 open-heart surgery patients was undertaken. Four of 17 were either HBsAg or anti-HBs positive. No correlation between infection and contact with three of four ill staff members or receipt of blood products was noted; however, 22 (46%) of 48 arterial blood gas specimens had been obtained from infected patients by one staff member, an inhalation therapist; this compared with seven (4%) of 157 specimens she obtained from control subjects (P less than 0.001). Furthermore, she handled indwelling arterial cannulae 25 (76%) of 33 times in infected patients compared with three (3%) of 95 times in control subjects (P less than 0.001). Transmission may have occurred via the arterial cannulae from a severe exudative dermatitis on the therapist's hands.
在两个月的时间里，医院工作人员中出现了4例乙型肝炎病例。三个月后，在这些工作人员感染时因心脏直视手术住院的两名患者患上了急性乙型肝炎。所有6名患者的血清均为ayw亚型且e抗原阳性。流行病学调查显示，这4名工作人员在3个月前接触过一名无症状的乙型肝炎表面抗原阳性（HBsAg）且e抗原也呈阳性的患者。为了确定是否存在从工作人员到患者的传播，对17名心脏直视手术患者进行了研究。17名患者中有4名HBsAg或抗-HBs呈阳性。未发现感染与接触4名患病工作人员中的3名或接受血制品之间存在关联；然而，48份动脉血气标本中有22份（46%）是由一名吸入治疗师从感染患者处采集的，而她从对照受试者处采集的157份标本中只有7份（4%）（P<0.001）。此外，她在感染患者中处理留置动脉套管的次数为33次中的25次（76%），而在对照受试者中为95次中的3次（3%）（P<0.001）。传播可能是通过该治疗师手上严重的渗出性皮炎经动脉套管发生的。
