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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 ([email protected])
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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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