Antipsychotic medication injections were administered by psychiatrists. Infection Control Assessment and Record Review The ALF had no written infection control policy. We observed lapses in infection control practices. When observed performing full report AMBG or injecting insulin, staff sometimes failed to wash hands or change gloves between residents. Staff struggled to don gloves, suggesting glove use was not routine practice, especially for staff with long fingernails. Staff in each building performed AMBG for residents, and blood samples were routinely obtained by using a single ACCU-CHEK? Softclix (F. Hoffman-La Roche, Ltd., Basel, Switzerland) reusable lancet-holding fingerstick device. A new lancet was inserted for each fingerstick, but the fingerstick device, which is intended for personal use, was used for multiple residents.

Blood glucose readings were obtained with a single meter device in each building. The meter was not cleaned or disinfected between uses. No resident performed self-monitoring of their own blood glucose. Staff and resident interviews and record review produced limited information about resident HBV-related risk behaviors. Sexual contact was uncommon in the facility and unknown to have occurred among residents uninfected before the investigation. Injection-drug use and sharing of personal care items could not be reliably assessed. Serologic Testing HBV serologic status was determined for 126 residents (91%) (Figure 1). Of these, 5 (4%) had chronic infection (2 were known to be infected before the investigation).

Thirty-three (26%) were immune (24 had evidence of past infection; 9 vaccinated). Fourteen residents (11%) had acute infection and 74 (59%) remained susceptible to infection. Two (14%) residents with acute infection were hospitalized with hepatitis symptoms, and 12 (86%) were asymptomatic and diagnosed on the basis of serologic screening. Serologic status was unknown for 10 ALF residents who refused serologic testing and for 3 ALF residents whose results were ambiguous. Figure 1 Flowchart Depicting Results of Serological Testing for Hepatitis B Virus Among Assisted Living Facility* Residents and Identifying Members of Cohort for Risk Factor Analysis. Retrospective Cohort Study Among 88 residents included in the retrospective cohort study, the attack rate was 16% (Figure 1).

Residents who experienced acute infection were similar to the total cohort in terms of age, sex, and race (Table 1). Mean length of stay at the ALF was shorter for acutely infected residents than for the total cohort. Among Dacomitinib 14 acutely infected residents, 11 (79%) lived in building 2; 12 (86%) had diabetes; 12 (86%) had received AMBG; 7 (50%) had received injected medications; 9 (64%) had received podiatry services; and 1 (7%) had received hemodialysis. Table 1 Characteristics of the Cohort of 88 Assisted Living Facility Residents, Virginia �C March 2010.