Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device

N Engl J Med. 1992 Mar 12;326(11):721-5. doi: 10.1056/NEJM199203123261101.


Background and methods: From June 1989 through March 1990, 26 patients, of whom 23 had diabetes, contracted acute hepatitis B virus (HBV) infection in a hospital in California. All 26 patients and one HBV carrier (also a diabetic) had been admitted to a single medical ward during the six months before the case patients became infected with HBV. To determine the source of the infection, we conducted a retrospective cohort study of the 72 patients with diabetes who had been admitted to the ward from January through December 1989 and a case-control study comparing the 3 nondiabetic patients who contracted hepatitis with 20 nondiabetic controls.

Results: The retrospective cohort study of all the patients with diabetes who were admitted to the ward during 1989 found that those who underwent capillary blood sampling by finger stick with a spring-loaded lancet device were more likely to contract HBV infection than those who did not have finger sticks (attack rate, 42 percent vs. 0 percent; P = 0.08). In addition, a dose-response relation was observed between the number of finger sticks received and the frequency of hepatitis B (P = 0.002). The case-control study found that all 3 of the nondiabetic patients who contracted hepatitis underwent finger-stick blood sampling with the device, as compared with none of the 20 nondiabetic controls (P = 0.0006). A review of nursing procedures indicated that the platform of the device was not routinely changed after each use; this finding suggested that contamination of the platform by HBV-infected blood was the mechanism of percutaneous transmission of HBV.

Conclusions: Proper use of finger-stick devices as well as strict adherence to universal precautions to avoid contamination by blood are required to decrease the possibility of transmission of blood-borne pathogens among hospitalized patients.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Blood Specimen Collection / instrumentation*
  • California
  • Case-Control Studies
  • Cohort Studies
  • Cross Infection / transmission*
  • Diabetes Mellitus / blood
  • Disease Outbreaks
  • Equipment Contamination
  • Female
  • Fingers
  • Hepatitis B / transmission*
  • Hospital Bed Capacity, 100 to 299
  • Hospitals, Veterans
  • Humans
  • Male
  • Middle Aged
  • Punctures / adverse effects*
  • Punctures / instrumentation
  • Retrospective Studies