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BMC Medicine
Published in: BMC Medicine 1/2009

Open Access 01-12-2009 | Research article

Patient to patient transmission of hepatitis B virus: a systematic review of reports on outbreaks between 1992 and 2007

Authors: Simone Lanini, Vincenzo Puro, Francesco N Lauria, Francesco M Fusco, Carla Nisii, Giuseppe Ippolito

Published in: BMC Medicine | Issue 1/2009

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Abstract

Background

Hepatitis B outbreaks in healthcare settings are still a serious public health concern in high-income countries. To elucidate the most frequent infection pathways and clinical settings involved, we performed a systematic review of hepatitis B virus outbreaks published between 1992 and 2007 within the EU and USA.

Methods

The research was performed using two different databases: the PubMed Database and the Outbreak Database, the worldwide database for nosocomial outbreaks. Selection of papers was carried out using the Quorom algorithm, and to avoid selection biases, the inclusion criteria were established before the articles were identified.

Results

Overall, 30 papers were analyzed, reporting on 33 hepatitis B virus outbreaks that involved 471 patients, with 16 fatal cases. Dialysis units accounted for 30.3% of outbreaks followed by medical wards (21.2%), nursing homes (21.2%), surgery wards (15.2), and outpatient clinics (12.1%). The transmission pathways were: multi-vial drugs (30.3%), non-disposable multi-patient capillary blood sampling devices (27.2%), transvenous endomyocardial biopsy procedures (9.1%), and multiple deficiencies in applying standard precautions (9.1%).

Conclusion

The analysis of transmission pathways showed that some breaches in infection control measures, such as administration of drugs using multi-vial compounds and capillary blood sampling, are the most frequent routes for patient-to-patient transmission of hepatitis B virus. Moreover some outbreak reports underlined that heart-transplant recipients are at risk of contracting hepatitis B virus infection during the transvenous endomyocardial biopsy procedure through indirect contact with infected blood as a result of environmental contamination. To prevent transmission, healthcare workers must adhere to standard precautions and follow fundamental infection control principles, such as the use of sterile, single-use, disposable needles and avoiding the use of multi-vial compounds in all healthcare settings including outpatient settings.
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Metadata
Title
Patient to patient transmission of hepatitis B virus: a systematic review of reports on outbreaks between 1992 and 2007
Authors
Simone Lanini
Vincenzo Puro
Francesco N Lauria
Francesco M Fusco
Carla Nisii
Giuseppe Ippolito
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2009
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-7-15

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