American Journal of Epidemiology Vol. 143, No. 10: 1042-1049
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Impact of Institution Size, Staffing Patterns, and Infection Control Practices on Communicable Disease Outbreaks in New York State Nursing Homes
1Department of Preventive Medicine and Biostatistics, Faculty of Medicine, University of Toronto Ontario, Canada
2School of Public Health, University at Albany, State University of New York Albany, NY
3Bureau of Communicable Disease Control, New York State Department of Health Albany, NY
4Bureau of Sexually Transmitted Disease Control, New York State Department of Health Albany, NY
Reprint requests to Dr. Guthrie S. Birkhead, Bureau of Communicable Disease Control, New York State Department of Health, Room 651, Coming Tower, ESP, Albany, NY 12237.
Institutional risk factors associated with the occurrence of nosocomial respiratory or gastrointestinal disease outbreaks in 1992 were examined in a case-cohort study of New York State nursing homes conducted in 1993. Facility size, staffing patterns, and employee sick leave policies were the principal effects found in an unconditional logistic regression model. The risk of having respiratory or gastrointestinal disease outbreaks was greater in larger nursing homes (adjusted risk ratio (RR) = 1.71 for each 100-bed increase in size, 95% confidence interval (Cl) 1.20–2.42), for nursing homes with a single nursing unit (adjusted RR = 3.93, 95% Cl 0.98–15.71), or those with multiple nursing units with shared staff (adjusted RR = 2.51, 95% Cl 1.07–5.89). The risk was less for nursing homes with paid employee sick leave policies (adjusted RR = 0.38, 95% Cl 0.15–0.99). Other potential risk factors examined in this study, such as the ratio of the beds per unit, type of sponsorship, daily review of laboratory test results, and the proportion of private beds and patient-to-staff ratio, were not significantly associated with the risk of disease outbreaks. The results of this study have direct implications for control of nosocomial disease outbreaks in nursing homes.
cross infections; disease outbreaks; infection control; nursing homes
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