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News

Hep B transmission with blood glucose monitoring

Hepatitis in any long-term-care resident should prompt an investigation, and residents with diabetes using fingerstick blood sampling procedures or insulin administration should receive particular scrutiny, finds this week's issue of JAMA.

News image

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An estimated 70,000 to 80,000 Hepatitis V infections occur each year in the United States.

Most of these infections occur among young adults with behavioral risk factors, such as sexual contact and injection-drug use.

However, outbreaks of Hepatitis B virus infections are also associated with glucose monitoring.

Hepatitis B outbreaks were due to shared devices related to blood glucose monitoring
Journal of the American Medical Association

Capillary blood is typically sampled with the use of a fingerstick device and tested with a portable glucometer.

Regular monitoring of blood glucose levels is an important component of routine diabetes care.

Therefore, the Centre for Disease Control and the Food and Drug Administration recommended since 1990 that fingerstick devices be restricted to individual use.

Dr Ranck and colleagues from the Centers for Disease Control and Prevention: Morbidity and Mortality describe 3 recent outbreaks of Hepatitis B.

The research team described the outbreak of the infection among residents in long-term-care facilities.

The outbreaks of Hepatitis B described were attributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring.

The researchers found that recommendations concerning standard precautions and the reuse of fingerstick devices have not been adhered to in long-term-care settings.

The team felts that the findings underscore the need for education, training, adherence to standard precautions.

The researchers also highlighted the need for specific infection-control recommendations targeting diabetes-care.

The team observed that initial cases were not identified or investigated in a timely fashion.

The delay in reporting initial cases resulting in missed opportunities to correct deficient practices and interrupt transmission.

Dr Ranck and colleagues on behalf of the Center for Disease Control conclude, “Routine Hepatitis B vaccination or screening of long-term care residents is not recommended.”

“Evidence of acute viral hepatitis in any long-term-care resident should prompt a thorough investigation.”

“For a case involving a resident with diabetes, fingerstick blood sampling procedures and insulin administration should receive particular scrutiny.”

“Health departments should encourage reporting of such cases and offer assistance in identifying the source of infection.”

"The Center for Disease Control and Prevention continues to support investigations to improve implementation of the infection-control recommendations described in this report.”

JAMA 2005: 294:35-38
08 July 2005

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