Hepatitis refers to inflammation of the liver. Although there are several potential causes of hepatitis, the illness is most commonly the result of a viral infection. Healthcare-associated hepatitis outbreaks most commonly involve hepatitis B virus (HBV) and hepatitis C virus (HCV), both of which are bloodborne pathogens and can result in chronic infections that may lead to cirrhosis or liver cancer.

Healthcare-associated hepatitis A virus (HAV) occurs infrequently. HAV is spread by the fecal-oral route, and transmission to healthcare personnel usually occurs when the source patient has unrecognized hepatitis and is fecally incontinent or has diarrhea.

In healthcare settings, transmission of HBV and HCV typically results from infection control breaches that expose patients to blood from another person. Examples include equipment reuse and cleaning/disinfection lapses during blood glucose monitoring and reuse of syringes or other means of contaminating parenteral medications (drugs administered via injection or infusion). Outbreaks have also resulted from drug diversion by HCV–infected healthcare workers.

Often, a person who is newly infected with HBV and HCV does not develop symptoms. When symptoms are present, they can take weeks to months to appear. For these reasons, outbreaks can be difficult to recognize. Even a single case of possible healthcare-associated HBV or HCV warrants investigation and follow-up, to rule out a larger problem.

Featured Resources:

• CDC offers a toolkit to help state and local health departments investigate possible healthcare-associated viral hepatitis transmission. The toolkit includes:
  • Summary of suggested investigation steps related to diagnosis, surveillance and case finding;
  • Sample Questionnaire to help identify potential healthcare exposures; and
  • Advice on patient notification and laboratory testing.
• The CDC Drug Diversion Website and CSTE Drug Diversion Toolkit provide useful background and guidance for investigating infections (such as HCV), stemming from drug diversion activities that involved healthcare providers who tampered with injectable drugs.
• This open access journal article summarizes U.S. outbreak investigations involving healthcare-associated HBV and HCV, including examples involving unsafe injections, dialysis and diabetes care.

Additional Resources:

• Reported Healthcare-Associated Hepatitis B and C Outbreaks | CDC provides information on healthcare-associated HBV and HCV outbreaks with >2 cases from 2008-2019.
• CORHA’s Bloodborne Pathogens and Injections
• The ABCs of Hepatitis for Health Professionals is a convenient summary of the epidemiology, natural history, treatment and prevention of HAV, HBV, and HCV.