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Nosocomial hepatitis A infection in a paediatric intensive care unit
Insights
A hepatitis A outbreak in a pediatric intensive care unit was linked to an infected patient. Staff risk factors included sharing food and cigarettes, highlighting the need for infection control measures.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Hepatitis A outbreaks can occur in healthcare settings.
- Nosocomial infections pose risks to both patients and staff.
- Identifying transmission routes is crucial for prevention.
Purpose of the Study:
- To investigate a hepatitis A outbreak in a pediatric intensive care unit.
- To identify risk factors associated with hepatitis A transmission among healthcare workers.
- To evaluate the cost-effectiveness of screening and prophylaxis.
Main Methods:
- Serological testing of healthcare staff.
- Prophylactic pooled gamma globulin administration.
- Questionnaire-based risk factor assessment (cases vs. controls).
Main Results:
- Nine individuals (seven staff, two relatives) contracted hepatitis A.
- A 13-year-old patient was the presumed source of infection.
- Risk factors for staff included sharing food, coffee, cigarettes, and eating in the ICU nurses' office.
- 23% of staff had pre-existing immunity.
- Healthcare workers under 40 born in the US were at higher risk.
- White individuals under 30 born outside the US were also at increased risk.
Conclusions:
- Sharing habits among healthcare workers can facilitate hepatitis A transmission.
- Targeted screening and prophylaxis are essential for controlling nosocomial hepatitis A.
- Cost-benefit analysis supports proactive infection control strategies.
Abstract:
Seven members of staff in a paediatric intensive care unit and two of their relatives developed hepatitis A over a period of five days. A 13 year old boy who was incontinent of faeces prior to his death, was presumed to be the source of infection. Two hundred and sixty seven other members of staff underwent serological testing and were given prophylactic pooled gamma globulin. Twenty three per cent were immune before exposure. Of people born in the United States, those at highest risk of developing the disease are physicians, dentists, nurses and those under the age of 40. Of those born outside the United States, being white and under the age of 30 are the two main risk factors. Data from a questionnaire sent to 19 nurses at risk (six cases, 13 controls) suggested that sharing food with patients or their families, drinking coffee, sharing cigarettes and eating in the nurses' office in the intensive care unit were associated with an increased incidence of hepatitis. Nurses with three or four of these habits were at particular risk. The costs of screening and prophylaxis were US $64.72 per employee, while prophylaxis alone would have cost US $8.42 per employee. Assessing risk factors on the one hand and costs of prophylaxis on the other are important elements in the control of nosocomial infections.