title: Infection control practices in assisted living facilities: a response to hepatitis B virus infection outbreaks.
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.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. app8@cdc.gov
authors.forename: Ami S
authors.initials: AS
authors.lastname: Patel
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: White-Comstock
authors.forename: C Diane
authors.initials: CD
authors.lastname: Woolard
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
mesh_terms: D040561:Assisted Living Facilities / Q000592:standards* / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000032:analysis; D004196:Disease Outbreaks / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D017053:Infection Control / Q000592:standards / Q000706:statistics & numerical data*; D008050:Lipid A / Q000008:administration & dosage / Q000031:analogs & derivatives; D011795:Surveys and Questionnaires; D013663:Teaching / Q000706:statistics & numerical data; D014768:Virginia
chemical_list: D001786:Blood Glucose; D017325:Hepatitis B Vaccines; D008050:Lipid A; C530461:hepatitis B vaccine AS04