Correspondence

Transmission of Hepatitis B Virus Associated with a Finger-Stick Device

N Engl J Med 1993; 328:969April 1, 1993

Article

To the Editor:

Polish et al. (March 12, 1992, issue)1 present data to indicate that an outbreak of acute hepatitis B virus infection at the Fresno Veterans Affairs Hospital in Fresno, California, was due to improper use of the Autolet device (Owen Mumford, Oxford, England), which we distribute. They determined this from the response to a questionnaire submitted to the nursing staff of the medical ward, rather than by examination of the purchase-order records of all finger-stick devices in the institution during the outbreak (March 15 through December 31, 1989).

Our technical personnel conducted an in-service education program on the use of the Autolet for the nursing staff of this medical ward in December 1989. We noted that other finger-stick devices, either provided as samples by company sales representatives or purchased by the institution, were also in use. Included were pen-like devices and other types of over-the-wound devices whose barrels may retain the patient's blood after the finger-stick procedure and that do not have a disposable platform. We immediately reported our findings to the hospital safety officer, who then directed that unapproved devices be removed from the institution.

Our invoice records indicate that from March 1988 through February 1990, 129 Autolet kits (containing 1 Autolet, 10 Unilet lancets, and 10 yellow platforms), 130 boxes of yellow platforms (200 per box), and 1040 boxes of general-purpose lancets (200 per box) were shipped to this institution. The institution ordered an excess of lancets over platforms. These lancets (Ulster item H-3300) were not designed to fit the Autolet, but do fit pen-like devices designed for home use by single patients for whom disposable platforms are not required. The Autolet requires Unilet lancets (Ulster item H-3400), which were neither ordered nor shipped during this period.

Finger-stick devices other than the Autolet were in use at this hospital and on the identified medical ward at the time of the outbreak, as evidenced by the type of lancet purchased. The Autolet has been in use since 1978 and has accounted for several billion safe finger sticks. Polish et al.1 were unable to recover hepatitis B antigen from either the Autolet or the underside of the platform.

The instructions for the use of the Autolet contained in the package insert indicate that when the device is used with more than one patient, both the Unilet blood lancet and the Autolet platform should be changed. The disposable platform is stamped “Use once only.”

David L. Marcus, Ph.D.
Peter F. Lordi, Jr.
Ulster Scientific, Inc., New Paltz, NY 12561

1 References

1. 1

   Polish LB, Shapiro CN, Bauer F, et al. Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device. N Engl J Med 1992;326:721-725
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Marcus and Lordi suggest that devices other than the Autolet finger-stick device were used on the medical ward and that they, rather than improper use of the Autolet device, may have contributed to the transmission of hepatitis B infection. Although other devices may have been used in the medical and surgical clinics, only the Autolet device was used on the inpatient medical ward. Marcus and Lordi claim that in-service training was conducted in December 1989, although there is no documentation of this in the hospital records. All but one of the patients who subsequently acquired hepatitis B infection were hospitalized on the medical ward at some time from June 1, 1989, through December 2, 1989. Therefore, transmission occurred before any training sessions in December 1989 (the exact dates of the hospital admissions were not included in our article). Finally, the review of the purchase records by Marcus and Lordi indicates that more lancets (not designed to fit the Autolet) were purchased than platforms. This is true and attests to the fact that 33 percent of the nursing staff did not routinely change the platforms. However, the lancet to which Marcus and Lordi refer does in fact fit the Autolet, and the nursing staff was routinely using it for the Autolet devices.

As we have mentioned before, the proper use of these devices, as well as strict adherence to universal precautions to prevent contamination by infected blood, will decrease the possibility of transmission of the hepatitis B virus and other blood-borne pathogens among hospitalized patients.

Louis B. Polish, M.D.
Centers for Disease Control and Prevention, Atlanta, GA 30333

Paulette Ginier, M.D.
Veterans Affairs Medical Center, Fresno, CA 93703

Citing Articles (1)

Citing Articles

1. 1

   E. F. DUFFELL, L. M. MILNE, C. SENG, Y. YOUNG, S. XAVIER, S. KING, H. SHUKLA, S. IJAZ, M. RAMSAY. (2010) Five hepatitis B outbreaks in care homes in the UK associated with deficiencies in infection control practice in blood glucose monitoring. Epidemiology and Infection1
   CrossRef