146571 Sticking it to them: Infection-control practices in Virginia assisted living facilities

Tuesday, November 6, 2007: 2:35 PM

Ami S. Patel, PhD, MPH , Philadelphia Department of Public Health/CDC, Philadelphia, PA
Joseph Perz, DrPH, MA , Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
Mary Beth White-Comstock, RN, CIC , Virginia Department of Health, Richmond, VA
Diane Woolard, PhD, MPH , Virginia Department of Health, Richmond, VA
Medical needs of the approximately 1 million persons residing in assisted living facilities (ALFs) continually become more demanding. Moreover, the number of ALF beds is expected to double by 2030. ALFs are not subject to federal oversight; state regulations governing infection control (IC) in ALFs are variable. In 2005, two outbreaks of acute hepatitis B (HBV) in Virginia ALFs were associated with sharing finger-stick devices, despite recommendations against this practice. We initiated a study to characterize IC practices, determine compliance with guidelines, and identify educational and policy needs

We sent letters to Virginia ALFs informing them of IC guidelines and recommendations regarding glucose monitoring. A follow-up survey consisting of on-site interviews with supervisors was conducted among a size-stratified random sample of ALFs. Differences among IC practices according to size and ownership were assessed by using chi-square.

Forty-nine of 155 central Virginia ALFs were surveyed. Forty-four ALFs had used penlet finger-stick devices, and six (14%) had shared these without cleaning between residents. Sharing practices did not differ by facility size or ownership. Only 16% used safety devices including safety lancets and autodisabling needles. Thirty-five percent of ALFs did not offer employees HBV vaccine as required by the Occupational Safety and Health Administration. HBV vaccine was less frequently offered at ALFs that had <50 residents (P=<0.01) or were individually owned (P=0.01).

Despite outreach and long-standing recommendations, >35% of ALFs surveyed were noncompliant with federal guidelines. Public health and licensing agencies should work with ALFs to implement IC measures in preventing disease transmission.

Learning Objectives:
1. Recognize importance of infection control (IC) guidelines and training for assisted living facilities (ALFs). 2. Identify deficiencies in assisted living facility (ALF) compliance with the Occupational Safety and Health Administration (OSHA) bloodborne pathogen standard. 3. Discuss how infection control in assisted living facilites can be improved at the state level.

Keywords: Disease Prevention, Infectious Diseases

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.