An Outbreak of Hepatitis A in an Intensive Care Unit

Abstract

We describe an outbreak of hepatitis A that occurred in an Intensive Care Unit (ICU) in a regional hospital in North Queensland. Seven people were infected including two patients, two close contacts of the index patient and three ICU nursing staff. The index case was admitted with an overdose and multiple trauma; he was not suspected to be incubating hepatitis A. The outbreak was initiated as a result of inadequate precautions taken whilst handling the index patient's bile. Problems identified upon reviewing the outbreak were inadequate terminal cleaning of equipment, food consumption in the ICU and inadequate handwashing practices. Implementation and maintenance of standard infection control practices is vital if further outbreaks of hospitalacquired hepatitis A and other enteric infections are to be avoided. We also suggest that the inactivated hepatitis A vaccine be considered for ICU staff.

Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020

“…Outbreaks of hepatitis A caused by transmission from patients to health care personnel are typically associated with fecal incontinence and inadequate hand hygiene ( 16 ), although most hospitalized patients who have HAV infection are admitted after onset of jaundice, when they are beyond the point of peak infectivity ( 17 , 18 ). In hospitals, sharing food or beverages between patients, families, and health care personnel has been associated with HAV transmission ( 19 , 20 ). Host-specific factors to consider when assessing for increased risk for HAV transmission in the health care setting include health care personnel with hepatitis A working during the infectious period or working with symptoms including diarrhea, and patients with hepatitis A who are diapered or incontinent and symptomatic, including diarrhea.…”

“…Outbreaks of hepatitis A caused by transmission from patients to health care personnel are typically associated with fecal incontinence and inadequate hand hygiene ( 16 ), although most hospitalized patients who have HAV infection are admitted after onset of jaundice, when they are beyond the point of peak infectivity ( 17 , 18 ). In hospitals, sharing food or beverages between patients, families, and health care personnel has been associated with HAV transmission ( 19 , 20 ).…”

Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland

“…Two prolonged, extensive community‐wide epidemics occurred during the decade (Box 1) and led to many occupational exposures to the hepatitis A virus, and several nosocomial outbreaks in this area (which has a southern boundary approximately defined by a line between Mackay and Mt Isa) 2 . ‐ 4 …”

“…1 Two prolonged, extensive community-wide epidemics occurred during the decade (Box 1) and led to many occupational exposures to the hepatitis A virus, and several nosocomial outbreaks in this area (which has a southern boundary approximately defined by a line between Mackay and Mt Isa). [2][3][4] Outbreaks of hepatitis A associated with child daycare centres were also prominent during that decade. For example, 18 such outbreaks were recognised over the 2 years 1998-1999, with infections in a total of 33 children, 62 of their household contacts and 10 staff members.…”