When residents started dying of hepatitis in a Wayne County assisted living facility in 2009, public health officials went looking for a cause. They found it in what they determined to be sloppy use of infection-tainted diabetes instruments by undertrained staff.
This month, a new law requiring specific infection control training for assisted living staff members takes effect. Its aim is to tamp down recurring diseases such as the hepatitis B that killed six residents in the Wayne center. Investigators said their lives could have been saved by cleaner practices and better trained staff.
As the state-mandated training gets under way, Duke University physician Dr. Thomas Bender, a former investigator for the Centers for Disease Control and Prevention, says the program stacks up well against other states' efforts to deal with an increasing number of hepatitis outbreaks caused by faulty diabetes care.
"I certainly look at this legislation as a model to hold up for other states," Bender said. "These rules are a lot more of a response to a very significant problem than you see elsewhere."
By the end of this year, about 30,000 medical technicians and their supervisors will receive a training course developed by the state divisions of Health Service Regulation and Public Health. By the end of next year, med techs in assisted living will get five hours of infection control training before they ever touch a patient, then another 10 hours after starting work.
Rep. Jennifer Weiss, a Cary Democrat; Rep. Mark Hollo, a Taylorsville Republican; and Sen. Bill Purcell, a Laurinburg Democrat and doctor, sponsored the bill requiring the training. It also mandates monitoring for infections and reporting outbreaks.
Better care, rising need
Dr. Zack Moore, medical epidemiologist with the Division of Public Health, said the legislation brings the training requirements for assisted living centers more into line with those at health care institutions.
"It's a real patchwork as far as what kinds of regulations and oversights occur in different settings - hospitals, nursing homes, assisted living," Moore said. "Adult care homes didn't have very much in the way of training before this bill, which is why it was thought to be important."
Public health officials say several colliding trends are increasing the number of infection cases in assisted living centers:
The rate of people 18 and older in North Carolina with diabetes more than doubled over a 10-year period, according to the state Center for Health Statistics.
The percentage of state residents older than 65 will increase from about 12 percent to about 20 percent by 2030. Given overall high percentages of people with diabetes, the sheer numbers of older patients with the disease is on the increase.
Many older adults who once would have received care in federally regulated nursing homes have gone to live in assisted living facilities, originally designed for people who mostly needed supervision and assistance with daily activities. As Medicare presses to more tightly control its spending, people who do not need treatment for acute conditions or are in rehab are being pushed out of nursing homes into assisted living centers.
Wayne County deaths
Six people who had been living at Glen Care Mount Olive, the Wayne County assisted-living center, died between June and late November 2009. In October, public health officials started examining the rash of deaths. They found that staff at the center had been passing around infections for more than four months by using and reusing fingerstick devices and other instruments needed to test blood and administer insulin.
The facility initially denied in a televised interview that it had any role in causing the deaths, but it paid $16,000 in fines after investigators found staff had caused the deaths by violating state rules.
"The investigation identified unsafe practices, including sharing of reusable fingerstick lancing devices approved for single patient use only and shared use of blood glucose meters without cleaning and disinfection between patients," CDC investigators reported.
In November, the federal Food and Drug Administration, concerned about frequent transmission of infection, warned medical professionals and even family members never to reuse devices used to draw blood for blood-sugar analysis. Only patients capable of analyzing their own blood sugar should reuse such devices, the FDA said.
"The FDA recommends that all fingerstick devices be labeled for use only on a single patient," the advisory said.
Minimal training
Reusable fingerstick devices should not even be present in a group setting where assisted monitoring is taking place, Bender said.
An investigation determined that staff had received minimal training in the processes designed to prevent transmission of disease among residents.
Peggy Smith, executive director of the North Carolina Association of Assisted Living Facilities, said centers across the state are in the process of offering or scheduling training, with the knowledge that the baby boom bulge means a wave of older, sicker residents is on the way.
"Sometimes it takes a crisis," Smith said. "The reality is that people are staying at home longer before they come to assisted living. And the longer people live, there's more chance that we'll be dealing with diabetes."
