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Nosocomial hepatitis A outbreak among healthcare workers and patients in a community hospital during an ongoing statewide outbreak

Published online by Cambridge University Press:  03 September 2020

Julia Brennan ,
Heather Mullins ,
Kelley Tobey ,
Cassandra Jones ,
Marion A. Kainer ,
Michelle Fiscus ,
Stephen May ,
John R. Dunn ,
William Schaffner Open the ORCID record for William Schaffner [Opens in a new window]  and
Timothy F. Jones
Julia Brennan
Affiliation:
Tennessee Department of Health, Nashville, Tennessee Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Heather Mullins
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Kelley Tobey
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Cassandra Jones
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Marion A. Kainer
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Michelle Fiscus
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Stephen May
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
John R. Dunn
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
William Schaffner*
Affiliation:
Vanderbilt University Medical Center, Nashville, Tennessee
Timothy F. Jones
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
*
Author for correspondence: William Schaffner, E-mail: william.schaffner@vumc.org
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Abstract

Objective:

The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.

Design:

Case series.

Setting:

Community hospital.

Participants:

Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019.

Methods:

HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.

Results:

We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.

Conclusions:

A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 2 , February 2021 , pp. 139 - 141
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Foster, M, Ramachandran, S, Myatt, K, et al. Hepatitis A virus outbreaks associated with drug use and homelessness—California, Kentucky, Michigan, and Utah, 2017. Morb Mortal Wkly Rep 2018;67:1208–1210.CrossRefGoogle Scholar
Health Alert Network. Outbreak of hepatitis A virus (HAV) infections among persons who use drugs and personsexperiencing homelessness. Centers for Disease Control and Prevention website. https://emergency.cdc.gov/han/han00412.asp. Published 2019. Accessed March 28, 2019.Google Scholar
Chodick, G, Ashkenazi, S, Lerman, Y. The risk of hepatitis A infection among healthcare workers: a review of reported outbreaks and sero-epidemiologic studies. J Hosp Infect 2006;62:414–420.CrossRefGoogle ScholarPubMed
Guet, L, Desbois, D, Roque-Afonso, AM, Germain, JM, Merle, V. Investigation of a severe nosocomial outbreak of hepatitis A among healthcare workers and adult patients. J Hosp Infect 2011;78:65–78.CrossRefGoogle ScholarPubMed
Park, JY, Lee, JB, Jeong, SY, Lee, SH, Lee, MA, Choi, HJ. Molecular characterization of an acute hepatitis a outbreak among healthcare workers at a Korean hospital. J Hosp Infect 2007;67:175–181.CrossRefGoogle Scholar
Wiseman, R, Weil, L, Lozano, C, et al. Health care–associated hepatitis A outbreak—Texas, 2015. Morb Mortal Wkly Rep 2016;65:425–426.CrossRefGoogle Scholar
Goodman, RA, Carder, CC, Allen, JR, Orenstein, W A, Finton, RJ. Nosocomial hepatitis A transmission by an adult patient with diarrhea. Am J Med 1982;73:220–226.CrossRefGoogle ScholarPubMed
Council of State and Territorial Epidemiologists. Hepatitis A, acute 2012 case defintion. Centers for Disease Control and Prevention website. https://wwwn.cdc.gov/nndss/conditions/hepatitis-a-acute/case-definition/2012/. Published 2012. Accessed December 18, 2019.Google Scholar
Doshani, M, Weng, M, Moore, KL, Romero, JR, Nelson, NP. Recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for persons experiencing homelessness. Morb Mortal Wkly Rep 2019;68:153–156.CrossRefGoogle ScholarPubMed
Fiore, AE, Wasley, A, Bell, B, Division of Viral Hepatitis NC for ID. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep 2006;55(RR07):1–23.Google Scholar
Bolyard, EA, Tablan, OC, Williams, WW, et al. Guideline for infection control in health care personnel, 1998. Infect Control Hosp Epidemiol 1998;16:407–463.CrossRefGoogle Scholar
Seigel, JD, Rhinehart, E, Jackson, M, Chiarello, L, for the Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. Published 2007. Accessed August 8, 2020.Google Scholar