Multiple exposure of hospital employees to hepatitis B. Five case studies.

Five occurrences of multiple exposure of hospital employees to presumed cases of hepatitis B were documented in urban hospitals in Arizona in 1982. On each occasion employees were exposed before the patient's condition was known to be potentially infectious. In four hospitals, the exposed employees received hepatitis B immune globulin, some with no consideration for the actual extent of exposure; in the fifth hospital, hepatitis B vaccine was given. Procedures followed in the hospitals indicated problems in understanding the potential communicability of hepatitis B, transferring information between hospital units, using hospital charts to determine diagnosis, and obtaining serologic confirmation of hepatitis B. Costs to the hospital for attempted postexposure prophylaxis in these occurrences ranged from $982 to $7,998. Recommendations for overcoming the identified problems include development and dissemination of detailed procedures within hospitals, education for physicians and infection-control personnel regarding proper postexposure prophylaxis, and immunization of high-risk employees with hepatitis B vaccine.