An outbreak of hospital-acquired hepatitis B virus infection among patients receiving chronic hemodialysis

OBJECTIVE: To investigate a cluster of hepatitis B virus (HBV) infections b etween December 1995 and May 1996 among chronic hemodialysis patients in on e county. SETTING: Two dialysis centers (A and B) and a hospital (C) in one county. PATIENTS: Six case-patients who were dialyzed in one of two centers, A and B, and had all been hospitalized between January and February 1996 at hospi tal C. METHODS: Patient 1, usually dialyzed in center A, seroconverted to hepatiti s B surface antigen (HBsAg) in December 1995 and could have been the source of infection for the others, who seroconverted between March and April 199 6. Two cohort studies were conducted: one among patients dialyzed in center A, to determine where transmission had occurred, and one among patients di alyzed at hospital C at the time patient 1 was hospitalized, to identify fa ctors associated with infection. RESULTS: Four (15%) of the 26 susceptible patients dialyzed at center A bec ame infected with HBV. Hospitalization at hospital C when patient 1 was hos pitalized was associated with infection (P=.002). A cohort study of the 10 susceptible patients dialyzed at hospital C during the time patient 1 was h ospitalized did not identify specific risk factors for infection. However, supplies and multidose vials were shared routinely among patients, providin g opportunities for transmission. CONCLUSION: When chronic hemodialysis patients require dialysis while hospi talized, their HBsAg status should be reviewed, and no instrument, supplies , or medications should be shared among them.