Nosocomial viral hepatitis.

Viral hepatitis has long been recognized as a hazard in the health care environment. Nosocomial hepatitis B initially emerged in the setting of transfusion-associated infection and later in patients in dialysis units and on oncology wards. Health care workers are also at risk of acquiring nosocomial hepatitis B and more likely to acquire the infection from their patients than vice versa. Rare instances of nosocomially-transmitted hepatitis A have been documented, but hepatitis A virus excretion patterns in relation to onset of disease generally preclude significant transmission in the hospital setting. With virtual elimination of transfusion-transmitted hepatitis B, non A/non B hepatitis is the most significant cause of post-transfusion hepatitis and may occur in as high as 15 percent of the patients given multiple transfusions. Control of nosocomial viral hepatitis is based on the creation of environmental barriers specific for each viral agent. For hepatitis B, serologic surveillance of staff and patients in high risk areas, together with use of immunoglobulins for post-exposure prophylaxis and hepatitis B vaccine in susceptible persons, promises to significantly reduce nosocomial infection. Isolation procedures for patients admitted with hepatitis A or B are based on use of blood precautions for hepatitis B, modified enteric precautions for hepatitis A and a combination of both for non A/non B or etiologically unspecified hepatitis.