I recenlty attended a VDC Best Practice Summit and Angela Myrick spoke from the Virginia Departmenrt of Health, Division of Surveillance and Investigation. The title of the presentation was "Outbreak of Hepatitis B Among Diabetic Residents in Assisted Living Facilities". The findings were so upsetting that I feel compelled to share this information as I can easily imagine this scenario is played out in many institutions.
In Virginia, Hepatitis B is reportable and we are fortunate to have a division that actually follows up on these cases. What was found that 5 different Assisted Living Facilities had outbreaks of Hepatitis B that involved 29 patients al but 1 had diabetesl. During the inviestigation it was determined that these outbreaks were a result of medical assistants using a patient lancing device with the same lancet on mulitple patients or the same lancing device and glucometer and changed the lancing device. Angela stated that the aides felt is was easier to use one device and meter and test all the patients with diabetes than use each person's individual meter.
Assisted Living Facilities are not regulated the same way as hospitals and patients are required to provide their own meters, strips and lancets. You may not be aware but single use lancets are not readily available for the general public to purchase and does a physician prescribe a single use lancet to those in assisted living facilities? Also consider the cost as compared to a lancet.
It is reported that there are about 40,000 new cases of Hepatitis B diagnosed every year.IIn the elderly population the Hepatits B vaccine is not as effective as in younger individuals. Hepatitis B virus can last up to 72 hours on a surface, Guess where many of the fingersticks take place in Asssisted Living Facilities - the dining room. Although we all recognize the education that has been offered on transfer of blood bourne pathogens I wonder how much thought is given to educating those who actually perform the tests in many assisted living or nursing home facilities? Turnover in these institutions is high, training sessions teach how to perform the procedure on one patient but what should be different if you are performing the procedure on 10 patients. Angela found that hands were not washed between patients, gloves were not changed, meters were not cleaned, and muli use devices were used.
As an educator we can educate the public regarding these issues, should we consider reaching out to these facilities and offering an inservice program? In Virginia recommendations have been made to training facilites that provide certifications to address this issue. If you are interested I can share the slide presentation and Angela does a great presentation.