Hepatitis B and C in U.S.

In the last decade, more than 60,000 patients in the United States were asked to get tested for hepatitis B virus (HBV) and hepatitis C virus (HCV) because health care personnel in settings outside hospitals failed to follow basic infection control practices, according to a new study by the CDC.

This first full review of all the CDC investigations over the past 10 years of healthcare-associated viral hepatitis outbreaks appears in the January 6th issue of the journal Annals of Internal Medicine.

"This report is a wake-up call," said Dr. John Ward, director of CDC's Division of Viral Hepatitis. "Thousands of patients are needlessly exposed to viral hepatitis and other preventable diseases in the very places where they should feel protected. No patient should go to their doctor for health care only to leave with a life-threatening disease."

In the United States, transmission of HBV and HCV while receiving health care has been considered uncommon. However, a review of CDC outbreak information revealed a total of 33 identified outbreaks outside of hospitals in 15 states, during the past decade: 12 in outpatient clinics, six in hemodialysis centers and 15 in long-term care facilities, resulting in 450 people acquiring HBV or HCV infection.

Patients were exposed to these potentially deadly diseases because health care personnel failed to follow basic infection control procedures and aseptic technique in injection safety. Reuse of syringes and blood-contamination of medications, equipment and devices were identified as common factors in these outbreaks.

"More and more patients in the United States receive their health care in outpatient settings," said Dr. Denise Cardo, director of CDC's Division of Healthcare Quality Promotion. "To protect patients, infection control training, professional oversight, licensing, innovative engineering controls and public awareness are needed in these health care settings."

CDC officials say the report shows the need for ongoing professional education for health care providers, as well as consistent state oversight in detecting and preventing the transmission of bloodborne pathogens in health care settings.

CDC assists local health departments by providing routine surveillance, outbreak investigation support, field personnel and lab expertise. CDC also works with key partners to ensure adherence to proper infection control practices.

CDC and its partners are working to address this important patient safety problem through a number of efforts, including:

• Improving viral hepatitis surveillance, case investigation and outbreak response, such as support for health departments to thoroughly investigate all individuals identified to have HBV or HCV infection;
• Strengthening the capacity of state and local viral hepatitis prevention programs;
• Augmenting the CDC's National Healthcare Safety Network, the national surveillance system for tracking health care-associated infections, to collect outpatient setting information;
• Partnering with the Hepatitis Outbreaks' National Organization for Reform (HONOReform), a patient advocacy foundation, to create patient and provider education materials;
• Continued improvement of injection safety practices through educational outreach efforts with professional nursing and anesthesiology organizations;
• Working with partners in the dialysis, diabetes and long-term care communities to promote safe care practices;
• Working with regulators and professional societies to strengthen licensure and accreditation processes with emphasis on safe injection practices;
• Exploring ways to improve curricula in nursing and medical schools related to safe health care practices.