Infection control practices in assisted living facilities: a response to hepatitis B virus infection outbreaks.

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.

Assessment of applied epidemiology competencies among the Virginia Department of Health workforce.

OBJECTIVES: Epidemiologists play critical roles in public health. However, until recently, no formal standards existed for epidemiology practice. In 2005, the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists drafted Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) that provide a foundation for expectations and training programs for three tiers of practice. We characterized the Virginia Department of Health (VDH) epidemiology workforce and assessed its baseline applied epidemiology competency by using these competencies. METHODS: Epidemiologists representing multiple divisions developed an Internet survey based on the AECs. Staff who met the definition of an epidemiologist were requested to complete the survey. Within eight skill domains, specific competencies were listed. For each competency, frequency and confidence in performing and need for training were measured by using Likert scales. Differences among tier levels were assessed using analysis of variance. RESULTS: Eighty-eight people from 10 program areas responded and were included in the analysis. Median epidemiology experience was four years, with 52% having completed formal training. Respondents self-identified as Tier 1/entry-level (38%), Tier 2/mid-level (47%), or Tier 3/senior-level (15%) epidemiologists. Compared with lower tiers, Tier 3 epidemiologists more frequently performed financial or operational planning and management (p=0.023) and communication activities (p=0.018) and had higher confidence in assessment and analysis (p<0.001). Overall, training needs were highest for assessment/ analysis and basic public health sciences skills. CONCLUSIONS: VDH has a robust epidemiology workforce with varying levels of experience. Frequency and confidence in performing competencies varied by tier of practice. VDH plans to use these results and the AECs to target staff training activities.

A statewide survey of nosocomial infection surveillance in acute care hospitals.

Increasingly, states are considering mandating the reporting of nosocomial infection data. To determine the impact of potential legislation, a questionnaire was mailed to the infection control department of each hospital in Virginia to assess the size of the infection control workforce and methodologies used for nosocomial infection surveillance. Most hospitals (64%) had 1 ICP full-time equivalent (FTE), and, at 86% of hospitals, the ICPs had other major responsibilities. The estimated mean additional ICP FTE required to perform hospital-wide surveillance was 1.7. Statewide, an additional 160 ICPs at an estimated annual cost of 11.5 million dollars would be required if reporting of all nosocomial infections were mandated.

Laboratory model of a petroleum migration barrier in arctic alaska

Child's Pad is a gravel construction pad that was contaminated with petroleum during oil-field service operations in Deadhorse, AK. As part of a remedial action plan, a buffer strip of uncontaminated sandy gravel was placed along certain sections of the pad boundary. A peroxygen formulation manufactured by Regenesis Copyright, sold as Oxygen Release Compound (ORC(R)), was placed in the buffer strips. The ORC was intended to supply oxygen to aerobic microorganisms capable of degrading petroleum. Tests were conducted in a 1/2 scale laboratory cell to determine the oxygen release characteristics of the ORC when subjected to expected subsurface flow rates of up to 0. 02 l/s (6.9 m/day). In laboratory tests, a zone of enhanced oxygen concentration was formed down-gradient from the ORC socks. Only during periods when the flow rate was less than 0.01-0.015 l/s (3. 5-5.2 m/day) was ORC-oxygen observed at monitoring points up-gradient or directly cross-gradient of the ORC. Conclusions from the laboratory study were that ORC may provide an aerobic zone in the Child's Pad barrier as far as 1 m directly down-gradient of the sock during periods of high flows (6.9 m/day). Copyright 1999 Elsevier Science B.V.

Oxygen release kinetics from solid phase oxygen in Arctic Alaska.

Child's Pad is a gravel construction surface that was contaminated with petroleum during oil-field service operations in Deadhorse, Alaska. As part of a remedial action plan, a buffer strip of uncontaminated sandy gravel was placed along sections of the pad boundary. A magnesium peroxide formulation manufactured by Regenesis, and sold as Oxygen Release Compound (ORC), was placed in the buffer strips. The ORC was intended to supply oxygen to aerobic microorganisms capable of degrading petroleum. Studies were conducted in the laboratory to determine initial oxygen release kinetics from ORC in contact with barrier soil. Studies quantified the biotic and abiotic catalytic mechanisms for converting hydrogen peroxide (a possible MgO2 intermediate) and ORC to oxygen and water, the effects of temperature on oxygen release from ORC, and the effect of field exposure on ORC viability. Barrier soil exhibited sufficient catalytic activity to convert hydrogen peroxide to oxygen faster than the expected biological demand. The oxygen evolution rate (OER) from ORC was lower at 7 degrees C than 21 degrees C by more than two times. The ORC recovered from Child's Pad after less than 1 year retained nearly all of the original available oxygen, although physical bridging was evident.

Collaborative working with specific speech & language disorder in mainstream education.

Children with specific speech and language disorders are part of a special needs population whose educational and therapeutic needs have been provided for in a variety of settings over the last fifty years. Changes have been implemented in response to a range of legislation. This has also had implications for the delivery and type of provision of the children's education and therapy. The National Health Service and local education authorities (LEAs) have had to respond to legislation and continue to provide for the full range of specific speech and language disorders. This paper will outline how therapeutic input has had to adapt to the changing educational context. Changes in delivery have necessitated a redefinement of roles and adjustments in collaborative working.

Fatal occupational electrical injuries in Virginia.

Work-related electrical injuries and fatalities in Virginia were reviewed for the period 1977 to 1985. Of 196 workers electrocuted (0.9/100,000/year), 65% (127) died between May and September. Death rates were highest for male workers in utility companies (10.0/100,000), mining (5.9/100,000), and construction industries (3.9/100,000), but these high risk groups accounted for only 50% of the deaths. Most accidental electrocutions resulted from power line contact (53%) and machine or tool usage or repair (22%). Only 1.5% (2/101) of the workers who died within 6 hours of injury and had blood alcohol concentration tested were legally intoxicated. All workers need safety education on active measures to prevent hazardous electrical exposures, not just those at high risk for electrical injury. Every work-related electrical injury represents a sentinel health event--an opportunity for preventive intervention in the workplace.