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The two residents with probable acute HBV infection were excluded from the study; it could not be determined with certainty that their infections were acute. The results of the medical record extraction and statistical analysis are included in Table 1. Residents with diabetes mellitus (RR=30.0, 95% CI=1.7�C525, P http://www.selleck.cn/products/3-methyladenine.html of infection; all five confirmed cases, as well as the two probable cases, shared these characteristics. Insulin injection was also significantly associated with acute HBV infection (RR=7.4, 95% CI=1.2�C41, P=.03). Three of the five confirmed cases received insulin. Insulin was administered at the same time as fingerstick testing was performed, and it was not possible to separate those two variables during the analysis. Including the two probable acute cases in the analysis further strengthened these associations (diabetes mellitus status: RR=42.2, 95% CI=2.2�C644, P http://www.selleckchem.com/products/PF-2341066.html blood glucose monitoring: RR=36.2, 95% CI=2.1�C613, P http://www.selleckchem.com/products/r428.html and the X gene, as well as a significant part of polymerase gene, were sequenced. All six sequences were identical and belonged to HBV subgenotype A2, predicting the adw2 subtype (Figure 1). Two HBsAg-positive residents refused an additional blood draw for this test. At Facility A, the DON had responsibility for infection control oversight; she had worked at the facility for 3 months and had no formal certification in infection control. The two LPNs conducting fingerstick glucose monitoring began work at the facility in October 2006, during the estimated exposure period. The nurses could not identify any changes in procedure between August 2003, when Facility A opened, and late 2006, when the exposures occurred, that would explain the outbreak. The facility required nurses to undergo infection control training, including risks for bloodborne pathogen transmission, twice a year and at hire. A nurse from the company supplying the glucose monitoring equipment reportedly gave residents and staff diabetes mellitus education quarterly.