Current Issues

Nursing Home Infection Reporting Requirement Update
Posted: March 7, 2009
On Saturday, February 28 2009, a public notice was published in the Pennsylvania Bulletin for the purpose of updating nursing homes on the healthcare-associated infection (HAI) reporting requirements. Please access the following link to the Bulletin for specific information including rollout dates for the different regions, as the original date of April 1 has been pushed back to June 2009. Click to review.

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Living with Dementia
Posted: December 26, 2006
Published November 2006 by Dale K Hursh, MD of Lancaster General
MS PowerPoint Presentation

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The New F-Tag 315
Posted: December 18, 2006
Published November 2006, Deborah Lekan-Rutledge. JAMDA
Adobe PDF Document

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The Newly Revised F-Tag 315 and Surveyor Guidance for Urinary
Incontinence in Long Term Care
Posted: December 18, 2006
Published November 2006, Theodore M. Johnson, II, MD, MPH, CMD, and Joseph G. Ouslander, MD, CMD. JAMDA.
Adobe PDF Document

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Hepatitis Outbreaks Linked To Use of Glucometers and Fingerstick
Glucose Measurements

Date: March 24, 2005
Pertinence: All LTC Facilities

Importance: High, Level 1
(Level 1 – Threat Likelihood Assessment = possible to be present. Jeopardy Assessment = Potential for serious outcomes. Level 1 items should prompt review of information immediately and facilities should review current processes and education needs.)

Description: Below is a link from the CDC describing 3 nursing home outbreaks of hepatitis B. Please review the article. It gives the details and helpful descriptions of what went wrong at these facilities. Recommended practices are included in this link.

Link: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm

Summary: Three outbreaks of hepatitis B, including fatal cases were recently investigated by the CDC. These cases occurred in either nursing facilities or assisted living facilities. In all cases, spread of hepatitis B virus was clearly linked to use of glucometers, fingerstick equipment including lancets and spring loaded devices, and failure of staff to maintain proper infection control precautions. In particular, staff failures included:

1. not cleaning the glucometer machines and/or spring loaded devices after EACH patient use.
2. not using new lancets for each patient
3. not changing gloves after testing each patient
4. not using gloves at all
5. not investigating or reporting hepatitis B cases promptly

Suggestions:

1. Review your fingerstick glucose testing processes carefully, making sure the machines and equipment are cleaned after each patient use.
2. Reinforce handwashing and glove use.
3. Make sure staff change gloves between patients
4. Never re-use a lancet.
5. Review necessity of frequency of fingerstick measurements with physician staff.
6. Develop policies that reduce excessive use of fingerstick measurements, yet which optimize glucose control within the context of the patient’s condition and prognosis.
7. Promptly investigate and report all acute cases of hepatitis B. UPIA can provide general guidance to your facility in such situations.
8. Foster methods for reporting infection control/patient safety concerns to facility leaders. Importantly, allow methods for anonymous reporting.

Comments: These cases are particularly distressing and highlight the importance of maintaining standard precautions in all situations. They also highlight the need for ongoing surveillance of infections in the LTC setting. This list of suggestions is not all-inclusive and each facility should individually review their processes carefully, taking actions consistent with established infection control practices.


David A. Nace, MD, MPH
Director, Long Term Care
University of Pittsburgh Institute on Aging
naceda@msx.upmc.edu