Maximizing health department resources to identify and prevent outbreaks of healthcare associated transmission of viral hepatitis

BACKGROUND: Transmission of viral hepatitis from healthcare associated exposures is of increasing concern in light of recently recognized outbreaks of hepatitis B and C. Prompt identification and investigation of suspected healthcare associated cases is needed to ascertain the source of illness and to implement appropriate control measures. However, local health department resources are limited and the burden of hepatitis makes prioritization and investigation of cases difficult.

METHODS: A cross-sectional survey was conducted to assess hepatitis investigation practices in New Jersey. Respondents were asked about the investigation of routine hepatitis B and C reports as well as cases with healthcare associated exposures.

RESULTS: The survey results showed that current investigation guidelines were not effective in identifying acute cases or those with healthcare associated exposures. Additionally, staffing resources were not optimized and considerable time was spent on tasks having minimal public health impact. By targeting investigations to identify cases that have the potential for an effective public health response, local resources can be maximized and disease burden reduced.

In response to the survey results, training needs were identified, local investigation guidelines were developed, and triggers for investigation of suspect acute or healthcare associated cases were delineated.

Three training needs identified: 1. Laboratory test interpretation and case classification 2. Infection control for ambulatory care and other healthcare settings 3. Standardized hepatitis investigation guidelines and forms

CONCLUSION: These training needs were incorporated into the local investigation guidelines. By prioritizing viral hepatitis investigation, local investigation resources are optimized to provide maximum public health impact.