03/17/11 — Board of Health says assisted living facilities need more oversight

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Board of Health says assisted living facilities need more oversight

By Phyllis Moore
Published in News on March 17, 2011 1:46 PM

There is a need for regulations governing the inspection and reporting at assisted living and adult care homes, Health Director James Roosen says.

Since the hepatitis B outbreak that spread to eight residents at GlenCare of Mount Olive last year, resulting in six deaths, local and federal health officials have debated the need for more vigilance in infection control.

An investigation at the time turned up violations that included unsafe sharing of blood glucose monitoring equipment and the likelihood that faulty procedures had spread the illness.

During last month's Board of Health meeting, Roosen said he would favor more extensive efforts for inspections of such facilities.

On Wednesday, he presented a three-page outline to the board on how to expand existing state regulations and control sanitary conditions.

His proposal encompassed three areas -- single-use procedures for blood testing, the way illnesses are reported and education of employees.

"We don't have any state health regulations that help us manage communicable diseases in nursing homes," he said. "Even though we're in there two times a year, they're not required to report to us."

Roosen said he hopes to begin discussions, first at the local level then the state, toward devising a plan and policies.

"We need to have a better relationship between public health, nursing homes and assisting living facilities," he said.

Even simply addressing how instruments are disinfected and ways to prevent cross-contamination would be a valuable start, he said.

"I have asked the state to look at expanding this and they have said they're not going to do it this year because they're up to their necks with budget (issues)," Roosen said. "Maybe after we meet with local providers we will have a better idea."

"It's amazing that the (state) doesn't clamp down harder on this," said board member Tommy Gibson. "They normally check these places every six months. For them not to pick up on this is just amazing."

Board member Dr. Kim Larson asked what the Health Department's role is in inspection facilities such as assisted living homes, which are different from nursing homes.

The environmental health section is responsible for those inspections, just as they are for restaurants and day cares, Roosen said. But the mode of inspection for assisted living and adult care homes is done differently.

"Mainly we inspect the kitchen, and then we go into the rooms, check for general cleanliness but it's basic inspection, not anything medical, anything to do with how to give an injection or anything like that," said Kevin Whitley, director of environmental health. "If they were getting ready to, say, check somebody's blood glucose level we would watch them (and) could ask them to show us their procedure just like when we go into a day care, to make sure they don't cross contaminate, we would look at that."

Dr. Larson expressed concern over one section of the proposal, calling for training to be provided to employees that draw blood, serve food, change linens or have physical contact with patients, over how that would be implemented.

Roosen, who wrote the proposal, said he felt it should be no different than what is currently being done with child care and day care center inspections.

"I realize there's going to have to be some training with our environmental health people," he said. "I think it would go a long way toward preventing illness.

"I think it's extremely important and, correct me if I'm wrong but right after this (hepatitis outbreak) it looked like we had a flu-borne illness. I heard it from (a facility owner's) son that lives in Wilmington .... if we had been notified right away, we could have done something to prevent it from happening again, stopping it midway."

The board did not take action on the proposal, and Roosen said he plans to spend the next month or so involving others in the discussion.

"This is just an idea that hopefully will be transferred into a Board of Health rule that will save lives," he said. "Education is needed. I think two or three workshops will be beneficial. ...

"There's a lot of work we need to do with this. I want to get a group of professional people together -- private individuals, private nurses from the hospital, public health folks -- and we'll sit around and look at this. This is just our first attempt."

"I would invite the owner of that Mount Olive (facility) to be at that meeting," Dr. Larson said.