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Infection Control Practices in Assisted Living Facilities: A Response to Hepatitis B Virus Infection Outbreaks

Published online by Cambridge University Press:  02 January 2015

Ami S. Patel ,
Mary Beth White-Comstock ,
C. Diane Woolard  and
Joseph F. Perz
Ami S. Patel*
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA Division of Surveillance and Investigation, Virginia Department of Health, Richmond, Virginia
Mary Beth White-Comstock
Affiliation:
Division of Surveillance and Investigation, Virginia Department of Health, Richmond, Virginia
C. Diane Woolard
Affiliation:
Division of Surveillance and Investigation, Virginia Department of Health, Richmond, Virginia
Joseph F. Perz
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
*
Philadelphia Department of Public Health, 500 S. Broad Street, Philadelphia, PA 19146 (app8@cdc.gov)
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Abstract

Background.

The medical needs of the approximately 1 million persons residing in assisted living facilities (ALFs) continually become more demanding. Moreover, the number of ALF residents is expected to double by 2030. ALFs are not subject to federal oversight; state regulations that govern ALF infection control are variable. In 2005, two outbreaks of acute hepatitis B virus (HBV) infection in ALFs in Virginia were associated with sharing fingerstick devices used in blood glucose monitoring.

Objective.

To characterize infection control practices, determine compliance with guidelines, and identify educational and policy needs in ALFs in Virginia.

Methods.

Following the outbreaks of HBV infection, educational packets were sent to ALFs in Virginia to inform them of infection control guidelines and recommendations regarding glucose monitoring. A follow-up survey consisting of on-site interviews was conducted in a random sample of ALFs. Differences among infection control practices, according to the size and ownership of the ALFs, were assessed.

Results.

Fifty of 155 ALFs in central Virginia were surveyed. Of the 45 ALFs that had used fingerstick devices, 7 (16%) had shared these devices (without cleaning) between residents. Sharing practices for glucose monitoring equipment did not differ by facility size or ownership. Of all 50 ALFs, 17 (34%) did not offer employees HBV vaccine. HBV vaccine was less frequently offered at ALFs that had fewer than 50 residents, compared with ALFs with at least 50 residents (P < .01), and HBV vaccine was less frequently offered at ALFs that were individually owned, compared with those that were not individually owned (P = .02).

Conclusions.

Despite outreach and long-standing recommendations, approximately 1 in 6 facilities shared fingerstick devices, and more than one-third of ALFs surveyed were considered noncompliant with federal guidelines (Occupational Safety and Health Administration Bloodborne Pathogens Standard). Public health and licensing agencies should work with ALFs to implement infection control measures and prevent disease transmission.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 3 , March 2009 , pp. 209 - 214
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Hawes, C, Rose, M, Phillips, CD. A National Study of Assisted Living for the Frail Elderly: Results of a National Survey of Facilities. Myers Research Institute and U.S. Department of Health and Human Services. December 14, 1999. Available at: http://aspe.hhs.gov/daltcp/reports/facres.htm. Accessed January 28, 2009.Google Scholar
2.National Center for Assisted Living Analysis of Data from U.S. Bureau of the Census. 1999 Statistical Abstract of the United States. No. 17, Resident Population by Age 1999 to 2030, page 17, middle series. Available at: http://www.census.gov/prod/99pubs/99statab/sec01.pdf. Accessed January 28, 2009.Google Scholar
3.The Senior Care Source: Facts, Figures, and Forecasts. Vol. 3. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2006.Google Scholar
4.Centers for Disease Control and Prevention (CDC). Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term care facilities—Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. MMWR Morb Mortal Wkly Rep 2005;54:220–223.Google Scholar
5.Centers for Disease Control and Prevention (CDC). Norovirus activity—United States, 2006-2007. MMWR Morb Mortal Wkly Rep 2007;56:842–846.Google Scholar
6.Zimmerman, S, Gruber-Baldini, AL, Sloane, PD, et al.Assisted living and nursing homes: apples and oranges? Gerontologist 2003;43:107–117.CrossRefGoogle Scholar
7.Mollica, RL. State policy and regulation. In: Zimmerman, S., Sloane, PD, Eckert, JK, eds. Assisted Living: Needs, Policies and Practices in Residential Care for the Elderly. Baltimore, MD: Johns Hopkins University Press; 2001.Google Scholar
8.Centers for Disease Control and Prevention. Blood glucose monitoring and the risk of viral hepatitis: recommended infection-control and safe injection practices. Available at: http://www.cdc.gov/hepatitis/Popula-tions/GlucoseMonitoring.htm. Accessed January 28, 2009.Google Scholar
9.Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34:122–127.CrossRefGoogle ScholarPubMed
10.Smith, PW, Rusnak, PG. Infection prevention and control in the long-term care facility. Infect Control Hosp Epidemiol 1997;18:831–849.CrossRefGoogle ScholarPubMed
11.Centers for Disease Control and Prevention (CDC). Nosocomial transmission of hepatitis B virus associated with a spring-loaded fingerstick device—California. MMWR Morb Mortal Wkly Rep 1990;39:610–613.Google Scholar
12.Quale, JM, Landman, D, Wallace, B, Atwood, E, Ditore, V, Frachter, G. Déjà vu: nosocomial hepatitis B virus transmission and fingerstick monitoring. Am J Med 1998;105:296–301.CrossRefGoogle ScholarPubMed
13.Khan, AJ, Cotter, SM, Schulz, B, et al.Nosocomial transmission of hepatitis B virus infection among residents with diabetes in a skilled nursing facility. Infect Control Hosp Epidemiol 2002;23:313–318.CrossRefGoogle Scholar
14.Louie, RF, Lau, MJ, Lee, JH, Tang, Z, Kost, GJ. Multicenter study of the prevalence of blood contamination on point-of-care glucose meters and recommendations for controlling contamination. Point of Care 2005;4:158–163.CrossRefGoogle Scholar
15.United States Department of Labor. Occupational Safety and Health Administration. Regulations (Standards—29CFR). Bloodborne pathogens. 1910.1030. Available at: http://www.osha.gov. Accessed January 28, 2009.Google Scholar
16.Makris, AT, Morgan, L, Gaber, DJ, Richter, A, Rubino, JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. Am J Infect Control 2000;28:3–7.CrossRefGoogle ScholarPubMed
17.Lindley, MC, Horlick, GA, Shefer, AM, Shaw, FE, Gorji, M. Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med 2007;32:459–465.CrossRefGoogle ScholarPubMed