Investigating potential spread through glucometers
Dr. David Allison.
Although health officials couldn’t pinpoint exactly how an outbreak of hepatitis B happened at a personal care home, Dr. David Allison suspects the shared use of a glucometer — a common tool to measure blood sugar — was the cause.
“The issue that came to us through this particular investigation is one that is actually quite concerning,” said Allison, who warned that the tools are susceptible to contamination even when the lancet — the disposable device used to prick the skin — is changed.
“We weren’t able to truly prove it, but the transmission through use of glucometers ... that’s really a concern quite broadly. It’s a very handy little instrument and all it takes is a little pinprick to get a sample. It’s very portable. It’s very easy to use.
It’s also very easy, if you are not thinking about it, to use on multiple people.”
Citing patient confidentiality, Eastern Health was reluctant to do an interview about its investigation into an outbreak of hepatitis B at a now-defunct personal care home. Allison, the region’s medical officer of health, was concerned about the privacy of those affected.
Eastern Health didn’t shut the home down because of the outbreak; it closed for other reasons.
Eastern Health tackled the outbreak in November 2009, while authorities were in the middle of the H1N1 flu panic.
Six people had developed hepatitis B as of January, according to a document obtained by The Telegram. The outbreak involved three acute infections, two resolved cases and one chronic carrier.
All those people were connected with the personal care home, including residents and staff.
Allison said he thinks public health staff — through strict infection-control measures — were able to stop the spread of hepatitis B.
But he acknowledged they can’t be sure.
And at least one other person contracted the virus, according to the family of Dorothy Manning, who lived at the home until she moved to another facility to be near her husband.
She was not diagnosed until after she had moved. Manning’s family say her husband tested positive for the virus four months ago.
Allison said hepatitis B is a challenging condition because of the incubation period and the fact that people can become infected without showing symptoms.
Officials don’t track every person who contracts the virus.
Allison said all possible precautions have been taken at facilities where hepatitis B is known to be present.
He noted that only 10 per cent of those infected go on to be chronic carriers, and a small number will develop serious conditions such as liver cancer.
Eastern Health told The Telegram that owners of personal care homes are responsible for following the standards of care set down in government regulations.
However, the health authority is supposed to monitor compliance with the standards through a team of community health nurses, social workers and dieticians.
A community health nurse and social worker visit each personal care home for that purpose at least every three months.
As a result of the investigation, the Department of Health has reinforced infection control standards with personal care homes, Allison said.
Although the homes are private facilities, Manning’s family say she was placed there through a social work team at St. Clare’s Hospital several years ago and her fees were subsidized by the province.
Eastern Health said its placement services determine care options through a comprehensive assessment process.
Manning’s family is frustrated because no one in the government or Eastern Health will accept accountability for the outbreak.
Under law, all personal care homes are supposed to have insurance.
Once a disease outbreak is discovered, Eastern Health said, the communicable disease control program team creates a contact list identifying individuals potentially engaged in “sexual, household or high-risk” activities with the infected person. Those are people who should be tested and offered vaccinations.
If it happens in an institutional setting, the contact list includes residents and staff who may be at risk.
Eastern Health said it informed people who needed to know through the contact list.
Personal care homes are not required to have their staff vaccinated, but Allison said Eastern Health recommends and provides vaccinations to all its staff in hospitals and nursing homes.
Since 1995, children in Grade 4 have been vaccinated, although that’s going to be changed to Grade 6.
The elementary school vaccinations began in 1995.
Allison said the public is likely unaware that glucometers can pose a contamination risk for different blood-borne illnesses and they should never be shared.