http://www.selleckchem.com/products/Sorafenib-Tosylate.html Several pieces of evidence support this hypothesis. Firstly, all 6 incident cases were admitted with the index case at least once between 4 May 2006 and 21 February 2007. Secondly, the index case and the 6 cases were sampled by a single multi-patient lancing device (this was the only device the nurses claim to be in use in the ward). Thirdly, the case control study showed that the median time of exposure to multi-patient lancing device while susceptible and admitted with the index case was significantly longer in cases than in controls. Fourthly, no more cases occurred after removal the multi-patient lancing device. Finally, the index case and 3 confirmed incident cases were infected with an identical HBV molecular variant which was eventually found on the multi-patient lancing device, while other coincidentally sampled cases revealed different molecular variants.

We hypothesize that the infections may have occurred by one or more of the following mechanisms: a) failure in changing the lancet, b) failure in changing the end-cap, c) infection of a new lancet occurred as consequence of contamination of the lancet holder (e.g.: blood spilling over into lancet holder; see figure 3 for multi-patient lancing device details). Alternative transmission routes seemed to be unlikely. Transmission by transfusion was excluded since no common donor was found between cases, indeed only 2 out 6 cases had been transfused. Moreover, the risk of HBV infection through transfusion is exceedingly low in Italy due to: strict controls on the units to be transfused [12] and the progressive reduction of HBsAg prevalence in healthy adults due to compulsory anti-HBV vaccination since 1992 [13].

Potential transmission through contaminated autologous hematopoietic stem cell, as described by Tedder et al [14], was ruled out by molecular investigation on liquid nitrogen. HCW-to-patients transmission was not likely as no HCW was found to be HBsAg positive [15]. Other potential risk factors [2] such as dialysis, the use of multi-dose 0.9% NaCl vials to medicate central venous catheter insertion sites, trans-venous endomyocardial biopsy, surgery, and active drug addiction seemed unlikely on the ground of the results of risk analysis and the clonal nature of the viruses found in the incident cases and the index case.

In particular, the significant association we found between HBV infection and length of exposure to multi-patient lancing device was unlikely to be affected by the potential increase of hospital staying due to acute hepatitis B. In fact, estimates were calculated according Dacomitinib to the time a patient stayed in hospital along the index case while susceptible (i.e. until the first HBV positive test or the onset of acute hepatitis). Although genotype D is the most frequent HBV genotype in Italy [16], genetic variability of HBV is high, due to the low fidelity of viral replication enzyme [17].