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Objective: The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations. Design: Case series. Setting: Community hospital. Participants: Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019. Methods: HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped. Results: We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b. Conclusions: A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.

A method for performing quantitative fit tests (QNFT) with N95 filtering facepiece respirators was developed by earlier investigators. The method employs a simple clamping device to allow the penetration of submicron aerosols through N95 filter media to be measured. The measured value is subtracted from total penetration, with the assumption that the remaining penetration represents faceseal leakage. The developers have used the clamp to assess respirator performance. This study evaluated the clamp's ability to measure filter penetration and determine fit factors. In Phase 1, subjects were quantitatively fit-tested with elastomeric halffacepiece respirators using both generated and ambient aerosols. QNFT were done with each aerosol with both P100 and N95 filters without disturbing the facepiece. In Phase 2 of the study elastomeric half facepieces were sealed to subjects' faces to eliminate faceseal leakage. Ambient aerosol QNFT were performed with P100 and N95 filters without disturbing the facepiece. In both phases the clamp was used to measure N95 filter penetration, which was then subtracted from total penetration for the N95 QNFT. It was hypothesized that N95 fit factors corrected for filter penetration would equal the P100 fit factors. Mean corrected N95 fit factors were significantly different from the P100 fit factors in each phase of the study. In addition, there was essentially no correlation between corrected N95 fit factors and P100 fit factors. It was concluded that the clamp method should not be used to fit-test N95 filtering facepieces or otherwise assess respirator performance.

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