A new study reveals that Hepatitis B Virus (HBV) infections were related to assisted monitoring of blood glucose (AMBG) among residents of assisted living facilities (ALFs).

Researchers at the Virginia Department of Health (VDH; Richmond, USA) examined acute HBV infections that occurred in residents of four separate ALFs in the Central Health Planning Region of Virginia (USA) that occurred between February 2009 and November 2011; in each outbreak, the initial acute HBV infections were identified through routine viral hepatitis surveillance. As a result, the VDH conducted epidemiologic and laboratory investigations of these reports and assessed infection control practices, particularly surrounding AMBG, by direct observation and staff member interviews.

The investigation and subsequent screening of ALF residents for HBV uncovered additional acute HBV infections at each of the ALFs. All acute HBV infections were among residents receiving AMBG for management of diabetes. The researchers identified lapses in infection prevention practices during AMBG at three of the four facilities, a procedure routinely delivered on-site by various unlicensed or licensed personnel, including medication aides, nurses, and others. The study was published in the May 18, 2012, issue of the Morbidity and Mortality Weekly Report (MMWR), published by the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA).

“These outbreaks highlight the role of hepatitis B surveillance in detecting disease outbreaks and the need for a comprehensive strategy to prevent HBV transmission in ALFs, including vaccination, improved infection control oversight at ALFs, appropriate training of staff members performing AMBG, and prompt investigation of acute HBV infections,” concluded lead author Yeatoe McIntosh, MPH, and colleagues.

The researchers recommended vaccination of adults with diabetes in this age group, based on the patient's diminished likelihood of responding to vaccine and the likelihood of acquiring HBV infection, including the risk posed by an increased need for AMBG in long-term–care facilities. Vaccination alone, however, is unlikely to completely eliminate HBV transmission risk in ALFs; in addition to HBV vaccination, the researchers recommend other interventions, including improving infection control oversight at ALFs, training staff members to appropriately perform AMBG, and ensuring that each ALF has a sufficient number of trained personnel to perform AMBG 7 days per week.

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