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

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.