Patient-to-patient transmission of hepatitis B in a dermatology practice

The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. Historical cohort, matched case-control, and cross-sectional survey methods were used. The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.