Identification and Response to Infection Prevention Breaches During Diabetes Care in Adult Care Homes — North Carolina, July, 2011–June, 2012

BACKGROUND: Outbreaks of hepatitis B virus infections in assisted living facilities have been reported frequently and are usually associated with infection prevention breaches during diabetes care. In 2011, the North Carolina General Assembly passed legislation intended to prevent transmission of bloodborne pathogens in adult care homes. This legislation established new infection prevention requirements and required the Division of Health Service Regulation to assess compliance as part of their routine surveys. Here we summarize infection prevention breaches identified during the first 12 months after this legislation was enacted and describe the associated public health responses. 

METHODS: Surveyors reported infection prevention breaches relating to blood glucose monitoring or injections to the North Carolina Division of Health Service Regulation. These reports were shared with the North Carolina Division of Public Health and subsequently with the local health department (LHD) for the county in which the facility was located. LHDs were asked to complete a report describing the investigation findings and public health actions taken.

RESULTS: Infection prevention breaches relating to blood glucose monitoring or injections were identified in 50 (6%) of 876 licensed adult care homes that underwent routine surveys during July 1, 2011–June 30, 2012. Breaches included sharing of glucose meters among multiple residents without cleaning and disinfecting between uses (n=49), sharing of lancing devices (n=7), and sharing of insulin pens (n=1). LHDs submitted reports for 27 facilities (54%). Public health responses documented in these reports included facility visits by LHD staff (n=22); assessing for clinical or laboratory evidence suggestive of acute hepatitis among exposed residents (n=19); searching state surveillance databases for reported hepatitis B virus infections among exposed residents (n=17); and laboratory testing of exposed residents for evidence of hepatitis B infection (n=3). LHDs provided education regarding best practices for assisted blood glucose monitoring and insulin injection in all instances. No evidence was identified to suggest that transmission of bloodborne pathogens had occurred as a result of these breaches.  

CONCLUSIONS: Routine assessment for infection prevention breaches during blood glucose monitoring and injections in adult care homes led to identification of opportunities for bloodborne pathogen transmission, most commonly sharing of blood glucose meters without cleaning and disinfection between uses. Collaboration between regulatory and public health agencies provides an opportunity to improve infection prevention practices and could allow for early identification of transmission events.