- The Washington Times - Thursday, March 10, 2005

Nursing-home residents in three states contracted the hepatitis B virus while undergoing routine blood-glucose monitoring for diabetes in 2003 and 2004, the Centers for Disease Control and Prevention (CDC) reported today.

Epidemiologists described the HBV cases in Mississippi, North Carolina and California — some of which were fatal — in the latest issue of the CDC’s Morbidity and Mortality Weekly Report.

The findings emphasize the need for “education, training and consistent enforcement of recommendations targeting diabetes-care procedures” in nursing homes to ensure there is no transmission of contagious illness, the CDC said.

Regular monitoring of the glucose level in the blood is an important feature of diabetes care because diabetics are likely to experience complications if their blood sugar gets too high or too low. The blood is sampled using a device to prick the finger or forearm, then measured with a device known as a glucometer, or glucose monitor.

“Because of outbreaks of HBV associated with such testing, the CDC and [the Food and Drug Administration] have instructed since 1990 that fingerstick devices be restricted to individual use,” the scientists said.

But they noted that some long-term care facilities have not gotten the message, citing three outbreaks of HBV among residents.

The first case involved a nursing home in Mississippi, where two patients died of acute HBV infection in late 2003, and a third subsequently contracted the virus.

Blood tests were conducted on all residents of the institution, and results showed that 15 residents, or 9 percent of the total, had acute HBV and another was chronically infected.

An investigation found that all residents with HBV were monitored at the same nursing station. One glucometer and one finger-stick device had been used and neither was disinfected between use on patients.

In another case early last year, the Los Angeles County Department of Health learned about four diabetics in an assisted-living center in that jurisdiction who had acute HBV. Investigators tested all diabetic residents at the center who had undergone finger-stick glucose monitoring in the previous six months and found that eight, or 36 percent, had acute HBV.

The probe showed that most patients who had daily finger sticks by nurses developed HBV, while diabetics who performed their own finger sticks did not. Staffers said nurses routinely performed finger sticks without wearing gloves or washing their hands between patients.

A third outbreak of HBV was reported in 2003 at a North Carolina nursing home. All residents were tested, and nearly one-fifth of those who received finger sticks for glucose monitoring were found to have acute HBV.

Staffers told investigators that on some days, health care workers performed as many as 20 finger sticks on patients per shift, without cleaning the glucometer.

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