Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to assess hospital infection control (HIC) policies by disease, hospital size, and services offered.

Background:
Because hospitals traditionally are primary reporters of vaccine-preventable disease (VPD) cases (via emergency rooms (ER) or among staff), a comprehensive HIC policy assessment can aid disease control/containment efforts with hospitals during a VPD case/outbreak among patients/staff.

Objectives:
Examine Los Angeles County (LAC) HIC policy existence and enforcement for measles, mumps, rubella, hepatitis B (hepB), varicella, pertussis, haemophilus influenza type B (Hib), and influenza exposures.

Methods:
During April-June 2004, a telephone survey was administered to LAC hospital infection control practitioners (ICPs), assessing HIC policy existence and enforcement. Results were analyzed by disease, hospital size, and services using logistic regression.

Results:
Of 93 responding hospitals, 53.8% had 200+ beds and 77.4% had ERs. Excluding hepB, isolation was the primary HIC measure. Second was respiratory droplet precautions for influenza, pertussis, mumps, Hib, rubella (range:24.7%-38.7%) and negative air pressure rooms for measles(46.2%), varicella(46.2%). For hepB, “standard precautions”(79.6%) was most frequent. Bed number and having ER services didn't statistically affect having a VPD-specific HIC policy. With regard to policy type, 200+ bed hospitals were more likely than <200 bed hospitals to indicate negative pressure rooms as a HIC measure (OR: 3.24; 95%CI: 1.25-8.40).

HIC employee compliance was enforced primarily through periodic review/observation and mandatory seminars (VPD range:76.3-71.0%; 14.0-17.2%, respectively). There were no statistical differences by bed number or having ER services for the existence or type of compliance enforcement. Twenty hospitals (21.5%) had no HIC enforcement for Hib, 16.1% for pertussis or influenza, 9.7% for hepB, 8.6% for mumps, 7.5% for rubella, 6.5% for varicella, and 5.4% for measles.


Conclusions:
Lack of uniform policies and enforcement will necessitate a higher level of involvement by the LAC health department when managing a VPD exposure/outbreak in hospitals.