Leslie D. Edwards, MHS¹, Dipti Shah, MPH¹, Brenda Roup, PhD, RN, CIC¹, Jessica Totaro, MPH², Karen Fujii, MHS³, and David Blythe, MD, MPH¹. (1) Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201, (410) 767-5776, ledwards@dhmh.state.md.us, (2) Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215, (3) American Red Cross, 15601 Crabbs Branch Way, Rockville, MD 20855

Introduction: Maryland law has long mandated reporting of outbreaks, which results in about 300-400 outbreak investigations each year. We reviewed long-term care facility (LTCF) outbreaks reported from 1993-2002 to determine whether the severity of outbreaks has increased over time. Methods: All LTCF outbreaks reported from January 1, 1993 to December 31, 2002 were reviewed to determine the illnesses reported. Data was compiled into two groups – an early period (1993-1997) and later period (1998-2002). The proportion of illnesses and number of cases were compared for the two periods. The number of hospitalizations and deaths per outbreak was also compared. Results: During 1993-2002, 1544 (48.0%) of the 3216 outbreaks reported were at LTCFs. Of these 1544, 704 (45.6%) were respiratory and influenza-like illnesses, 690 (44.6%) gastroenteritis, and 152 (9.8%) other illnesses including scabies, wound infections, and conjunctivitis. The proportion of respiratory illnesses among all LTCF outbreaks during the early period (45.5%) was not significantly different from the later period (45.6%) (p=0.97), and both groups had a similar mean number of ill cases (27.8 and 27.4, respectively) (p=0.79). The proportion of hospitalizations per outbreak was significantly higher during the later period (1.03 hospitalizations/outbreak) compared to the early period (0.75 hospitalizations/outbreak) (RR=1.38, 95%CI:1.26-1.51, p<0.001) as was the proportion of deaths per outbreak during the later period (0.35 deaths/outbreak) compared to the early period (0.22 deaths/outbreak) (RR=1.58, 95%CI:1.33-1.88, p<0.001). Conclusions: Maryland data suggests that the severity of outbreaks in LTCFs has increased in recent years. Additional studies are warranted to confirm this observation.

Learning Objectives:

• Identify number and type of outbreaks reported from long-term care facilities in Maryland
• Describe trends in severity of outbreaks over time
• Apply lessons learned directly to prioritization of infection control practices at long-term care facilites

Keywords: Outbreaks, Nursing Homes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.